JD Supra

Provider Wins $2M Appeal at ALJ Over Modifier 25, Random Sample

A cancer center has won its appeal of $2 million in Medicare claim denials in a case about modifier 25 and the extrapolation of an overpayment. Problems with the random sample underlying the ...
JD Supra

Use of Modifier 25 - 2017 Medicare Physician Fee Schedule Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) have reviewed the use of Modifier 25 to unbundle payments for evaluation and management (E/M) services when ...
Becker's ASC

When to Use CPT Modifiers 25 & 57

Current procedural terminology modifiers 25 and 57 may be confusing to some coders, but each serves a specific purpose, according to an AAPC report. For an evaluation and management visit when a ...
Becker's ASC

What to know when billing modifier -25 — 3 key pointers

Several commercial payers have adopted stricter reimbursement policies to deny modifier -25 claims upfront, according to Joette Derricks, a healthcare compliance and revenue integrity consultant who ...