MA03.003r, 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

By January 1, 2026: (1) Billing team must update billing system to remove Modifier 25 from the approved code list for CPT codes 33889, 33891, 37220, 37221, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 55700, 91122, and 92975. (2) Review and update claim edits to reject any claims submitted with Modifier 25 on these codes. (3) Providers must be notified that Modifier 25 is no longer appropriate for these procedures effective 01/01/2026. (4) For the 9 revised codes (10040, 55705, 61624, 61626, 92920, 92924, 92928, 92941, 92943), obtain updated policy attachment A documentation and review narrative changes to ensure accurate coding and documentation requirements. (5) Audit recent claims (last 90 days) for these codes with Modifier 25 and prepare for potential denials or corrections post-implementation. Failure to comply will result in claim denials and revenue loss.