Why was my office visit denied when billed on the same surgery date of service?

Modifiers may be required with some evaluation and management (E/M) services. In other cases, the E/M service may not be separately payable, such as certain visits performed on the day of a surgical procedure. Before submitting these services, ask yourself, 'Is this visit on the same day as I decided to perform the surgery? Is this the day before major surgery? Is this office visit a significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service?' If you answer yes to any of these, refer to the Modifier Lookup on Palmetto GBA’s website. CPT modifiers 24, 25 and 57 may be applicable. If an applicable service has been performed and the correct modifier is not on the E/M service, the E/M will be denied.

Contact Railroad Medicare

Email Railroad Medicare

Contact a specific Railroad Medicare department

Provider Contact Center: 888-355-9165

IVR: 877-288-7600

TTY: 877-715-6397

Other Palmetto GBA Sites

Palmetto GBA Home

DMEPOS Competitive Bid Program

JM Part A

JM Part B

JM Home Health & Hospice


Railroad Medicare Providers

Railroad Medicare Beneficiaries

National Supplier Clearinghouse


spacer spacer alt="spacer" spacer spacer spacer spacer spacer spacer spacer spacer spacer spacer