What is the primary purpose of modifier 25?

The primary purpose of modifier 25 is to signify that a significant, separately identifiable evaluation and management (E/M) service was performed on the same day as another procedure or service. When a provider conducts an E/M service that is distinct from another procedure performed on the same day, modifier 25 is appended to indicate that the two services are truly separate and not bundled together. This provides clarification for billing purposes, ensuring that the provider receives appropriate reimbursement for both the E/M service and the procedure performed.

In instances where modifier 25 is used, it indicates that the decision to perform the procedure was made after a thorough evaluation of the patient, ensuring that the medical necessity for both the E/M service and the procedure is well documented. This modifier is essential for accurately reflecting the complexity of the patient's care on that day.