Yes, you can add modifier 25 to code 99395. Modifier 25 indicates that a significant, separately identifiable evaluation and management service was performed on the same day as another service. In this case, it would suggest that a comprehensive preventive exam (99395) was conducted alongside an additional evaluation or treatment that warranted separate billing.
FALSE
No, you cannot report modifier 25 and modifier 52 on the same clinic visit. Modifier 25 indicates a significant, separately identifiable E/M service performed on the same day as another service, while modifier 52 is used to indicate a reduced service. Since they serve different purposes and imply different levels of service, using them together would not be appropriate in a single visit.
Modifier -51 is used in coding to indicate that multiple procedures were performed during the same session. For the code 51797, which refers to a specific procedure related to the urinary system, you would add modifier -51 if you are reporting multiple procedures and the payer requires it to indicate that the primary procedure is being billed alongside additional ones. However, if 51797 is the only procedure being billed, then modifier -51 is not necessary. Always check with the payer’s guidelines for specific requirements.
.25 x 60,000 = 15,000 add to get 75,000
example modifier and complement
no
Yes, however add 99203 modifier 25.
25
FALSE
Add on Codes Can not be billed with Modifier 51(multiple Procedures).
25
99395
add-on
The 25 modifier is typically added to the evaluation and management (E/M) service code that is billed separately when a procedure or service is performed on the same day. In this case, if both 99283 (Emergency department visit, low to moderate severity) and 99213 (Office or other outpatient visit, established patient) are billed, the 25 modifier is generally added to the code that represents the more comprehensive service. If both codes are necessary, ensure that the documentation supports the medical necessity for each service.
99395 is a routine exam ("check up") for an adult aged 18-39 who is not new to the practice. The preventive exam codes are broken out by age and by new or established status.
Need to bill with modifier 25
99395