Medicare AdvantageBilling CodesHigh impact
MA03.003s, 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, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated policy MA03.003s regarding Modifier 25 for significant, separately identifiable evaluation and management services performed on the same day as procedures. This affects how providers can bill E&M visits when performed with procedures on the same date.
Action Required
Before April 1, 2026: Billing team must review and update Modifier 25 usage guidelines in billing system. Providers must ensure E&M services are truly significant and separately identifiable when billed with procedures on same day. Update encounter forms and EMR templates to include Modifier 25 documentation requirements. Review current claims using Modifier 25 to ensure compliance with updated policy to avoid future denials.