Language Clarification: Proper Use of Modifier 25 When Billing for Allergy Testing and E/M Services on the Same Day

By September 1, 2026: Billing team must implement the following changes for Texas Medicaid allergy testing claims: (1) Update billing software to require modifier 25 on both the allergy testing procedure code AND the E/M service code (CPT 99201-99215) when billed on the same date of service; (2) Create a mandatory documentation checklist in the EMR to ensure providers document a significant, separately identifiable E/M service distinct from the allergy testing procedure; (3) Establish a claim submission process that attaches supporting clinical documentation with all same-day allergy testing + E/M claims; (4) Brief all providers and clinical staff that E/M services without proper documentation will be denied even if modifier 25 is present. Update encounter templates and billing forms to remind providers of these requirements. Failure to comply will result in E/M claim denials and payment recapture.