E/M Weekly Tip: Significant, Separately Identifiable Evaluation and Management Service

New patient codes (e.g., CPT codes 92002, 92004 and 99201–99205) are automatically excluded from the global surgery requirements and would not normally require CPT modifier 25 to be separately reimbursed from a surgical procedure.

• However, if the new patient code and surgical procedure is a National Correct Coding Initiative (NCCI) combination, CPT modifier 25 might be required
• New patient CPT codes require CPT modifier 25 when a separately identifiable E/M service is performed the same day as chemotherapy or non-chemotherapy infusions or injections as these are not considered surgery. For example, CPT codes 96401 and 96372.

For more details read the article below to learn more.

• JJ Part B - CPT Modifier 25
• JM Part B - CPT Modifier 25
• Railroad Medicare - CPT Modifier 25