MA03.003p, 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

Immediately: Billing team and providers must review and implement updated Modifier 25 requirements for Medicare Advantage plans. Update billing system edits to ensure proper use of Modifier 25 when billing same-day E&M visits with procedures. Train providers on documentation requirements for separately identifiable services. Incorrect modifier usage will result in claim denials.