Modifier 25
CPT modifier indicating that a significant, separately identifiable E/M service was performed by the same provider on the same day as another procedure or service.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Billing
- Primary sources
- 2
- Workspace handoff
- denial workbench →
Where this comes up
This shows up in revenue-cycle work — claim scrubbing, charge entry, posting, A/R follow-up, and month-end close. Billers and practice managers hit this term when reconciling a payment, working a denial queue, or auditing why a claim aged past 60 days.
Full definition
What it is in practice
CMS MLN 1783722 explains modifier 25 application. The E/M must be significant and separately identifiable beyond the usual pre- and post-procedure work; document the distinct chief complaint, history, exam, and MDM.
How it shows up in your practice
Modifier 25 is one of the most-audited modifiers. Use it when the E/M addresses a distinct problem from the procedure. Avoid universal application; payers use modifier-25 frequency reports to target audits.
Sources
- CMS MLN — Modifier 25https://www.cms.gov/files/document/mln1783722-proper-use-modifiers-25-and-59.pdf
- AMA — Current Procedural Terminology (CPT)https://www.ama-assn.org/practice-management/cpt
Defend modifier-25 denials in the Denial Workbench
Open denial workbench →Related terms
- BillingModifier 59CPT modifier identifying a distinct procedural service that is not normally reported together but is appropriate under the circumstances.
- CodingE/M CodingEvaluation and Management codes (99202-99499) used to bill office, hospital, and other professional visits.
- BillingGlobal PeriodThe period of time during which the payer considers most related preoperative and postoperative services bundled into the surgical fee.
- BillingG2211 (Visit Complexity Add-on)Medicare HCPCS add-on code recognizing the visit complexity inherent to evaluation and management services associated with primary care and certain longitudinal care.
- BillingNCCI EditsThe CMS National Correct Coding Initiative edits that prevent improper payment when incorrect code combinations are reported.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryModifier 59CPT modifier identifying a distinct procedural service that is not normally reported together but is appropriate under the circumstances.
- GlossaryG2211 (Visit Complexity Add-on)Medicare HCPCS add-on code recognizing the visit complexity inherent to evaluation and management services associated with primary care and certain longitudinal care.
- GlossaryGlobal PeriodThe period of time during which the payer considers most related preoperative and postoperative services bundled into the surgical fee.
- GlossaryNCCI EditsThe CMS National Correct Coding Initiative edits that prevent improper payment when incorrect code combinations are reported.
- GlossaryE/M CodingEvaluation and Management codes (99202-99499) used to bill office, hospital, and other professional visits.
- GlossaryCPT (Current Procedural Terminology)The AMA-maintained code set that describes medical, surgical, and diagnostic services for billing.
- BillingAWV + Problem Visit Same Day: How to Bill CorrectlyYes, you can bill AWV and a problem visit the same day. Here's how to do it correctly with modifier -25.
- RegulationModifier 25: Significant, Separately Identifiable E/M ServiceModifier 25 is appended to an E/M code when the E/M is significant and separately identifiable from another procedure or service performed on the same day by the same provider.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.