Medicare AdvantageBilling CodesHigh impact
MA03.003q, 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
Medicare Advantage has updated its policy MA03.003q regarding Modifier 25 for significant, separately identifiable evaluation and management services performed on the same day as procedures. This policy change affects how billing teams should apply Modifier 25 when E&M services are provided alongside procedures by the same provider.
Action Required
By April 1, 2025: Billing team must review and update billing procedures for Modifier 25 usage on Medicare Advantage claims. Review the complete policy at the source URL to understand specific requirements for documenting and billing separately identifiable E&M services when performed with procedures on the same day. Update billing software rules and provider documentation guidelines accordingly.