Modifier 25 and 59 update

I have an Updated modifier chart for you guys. We have been finding that the insurances are denying the immunization administration (90471) without a 25 modifier on the office visit and a 59 on the 90471. If you were using the old one, please replace it with the updated rules. For a more detailed explanation of how these modifiers work, please see the post from 01/11/13.

And this new chart is fancy and it’s typed and has examples. Hope it helps. I have also had a few inquiries on when to use the modifier 24 and 79, so my next post will be about how to use those effectively. Also, if anyone has a question for us, please do not hesitate to email or comment.



Filed under 96372, Billing, Claims, CPT, Doctor's Office, Medical Billing, Modifiers, Office Visit

5 responses to “Modifier 25 and 59 update

  1. Kathy Smith

    We billed a J3420 and 96372 to Medicare, they denied the 96372 as the patient had a cancer injection on the same day by another physician . What modifier would we use. We are family practice.

  2. Farrah

    We are Urgent Care and billing 99215, 24640 and 29105 on the same claim. I know I need to put a 25 on the E/M, but do I need a modifier for the others?

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