Question:

How much does Medicare pay for an evaluation and management (E & M) service assigned with a modifier 25?

Answer:

Currently, if a claim is received by CMS that includes an E&M service with a Modifier 25 and a procedure, both the E&M and the procedure are reimbursed at 100 percent of the allowed amount.

However, in the 2019 proposed Medicare Physician Fee Schedule rule, the Centers for Medicare & Medicaid Services (CMS) proposed that the reimbursement for the service with the lower value (either the E & M or the procedure) would be reduced by 50 percent. An article explaining the policy can be found at https://www.racmonitor.com/cms-proposes-50-percent-reduction-in-claims-submitted-with-modifier-25.

Facebook
Twitter
LinkedIn
Email
Print

CPT® copyright 2021 American Medical Association (AMA). All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.