Reporting Multiple Office Visits and Modifier - 25

06/10/2020

Date Issued: 06/10/2020

 

As per the CMS Claims Processing Manual, it states: If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty and subspecialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level. The CMS manual does not a state that modifier 25 would override this edit. If the diagnosis is related to the earlier visit, the provider should bill only one time with the level of service combined (but only one visit). Therefore, if multiple office visits are submitted with modifier 25 by the same provider for the same date of service with a related diagnosis the claim will deny.

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