CommercialBilling CodesMedium impact
03.00.06ac, Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
Independence Blue Cross·Coding
Effective date
Apr 1, 2025
We identified it
Jun 19, 2026
Summary
This is an updated policy regarding Modifier 25 usage for significant, separately identifiable evaluation and management services performed on the same day as procedures by the same provider. The policy provides guidance on proper billing practices for commercial insurance plans.
Action Required
By April 1, 2025: Billing team and providers must review updated Modifier 25 guidelines for commercial plans. Ensure documentation clearly supports separate E&M services when billed with procedures on the same day. Update billing system edits and provider education materials to reflect new policy requirements.