• Why You Don’t Need Modifier -25 on New Patient Exams


    Modifier -25 is defined as a significant and separately identifiable evaluation and management service by the same physician on the same day of the procedure. When you submit a minor procedure the same day as a new patient exam, you don’t need modifier -25.

    • The new-patient codes include 92002, 92004, 99201-99205, 99281-99285, 99321-99323 and 99341-99345.
    • You only need to append modifier -25 to the new patient exam if there is a CCI bundling edit for the procedure.
    • Minor procedures consist of those with a global period of 0 or 10 days.
    • The diagnosis on the exam may be the same or different from the procedure performed.

    Related resource: Palmetto GBA E/M Weekly Tip: Significant, Separately Identifiable Evaluation and Management Service.