Medicare AdvantageBilling CodesMedium impact
MA03.009e, Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
Independence Blue Cross·Coding
Effective date
Mar 5, 2025
We identified it
Jun 19, 2026
Summary
This policy clarifies the use of Modifier 24 for billing unrelated Evaluation and Management (E/M) services by the same physician during a postoperative period under Medicare Advantage plans. Billing teams must ensure proper documentation and modifier application to distinguish unrelated E/M visits from postoperative global period services to avoid claim denials.
Action Required
By March 5, 2025: Billing team must review and update coding guidelines for Modifier 24 application in the practice's billing system and provider education materials. Ensure all providers and coders understand when to append Modifier 24 to E/M codes for unrelated postoperative visits. Implement audit process to verify proper modifier usage on claims submitted to Medicare Advantage plans. Train billing staff to flag and review E/M claims during postoperative periods before submission. Failure to correctly apply Modifier 24 will result in claim denials or downcoding by Medicare Advantage plans.