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


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


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