Staying Compliant with Modifier -25: What You Need to Know

Few coding modifiers have drawn as much scrutiny as modifier -25. Used to indicate a significant, separately identifiable evaluation and management (E/M) service on the same day as another procedure, modifier -25 has long been a point of focus for third-party payors and government enforcement agencies. 

The concern? Improper or excessive use. Payers argue that modifier -25 is often applied incorrectly, leading to overbilling. Enforcement agencies have taken action against providers accused of misusing this modifier, with penalties ranging from denied claims to costly settlements. 

For compliance professionals and coding auditors, understanding the proper application of modifier -25 is essential. Key requirements include thorough documentation, clear evidence of medical necessity, and an explicit distinction between the E/M service and the procedure performed. Without these safeguards, providers may be at risk of audits, repayment demands, and reputational harm. 

In our upcoming webinar, experts will unpack the most important requirements for compliant use of modifier -25 and share practical strategies for mitigating risk. We’ll also review recent enforcement cases to highlight common pitfalls and lessons learned. 

Attendees will leave with actionable tools to protect their organizations, strengthen audit preparedness, and ensure billing practices align with regulatory expectations. Whether you’re a compliance officer, coding auditor, or revenue cycle leader, this session will help you build confidence in your compliance strategy.