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Printed Date: 9/22/2015
Is the E/M a significant, separately identifiable service?
If the answer is no, the service will not be reimbursed separately. If the answer is yes, submit CPT modifier 25;
Is the CCI indicator '0'?
These code pairs will not be reimbursed if submitted for the same date of service. Exceptions to CCI edits cannot be made for code combinations with an indicator of '0'.
Is the code indicator '1'?
Submit the appropriate modifier to show the service should be separate. Documentation is required in the patient's medical record. Exceptions to CCI edits can be made for code combinations with an indicator of '1'. Examples of separate, distinct services include situations in which the E/M visit was performed at a different patient encounter from the procedure with which it is bundled.
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Last Updated: 02/08/2018