General Question for the Week of September 3, 2018

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.