Modifier 25: Significant, separately identifiable evaluation and management service
When it is appropriate
Append modifier 25 to an evaluation and management code when a significant, separately identifiable evaluation and management service was performed by the same physician or other qualified health professional on the same day as a procedure or other same day service, and the visit's work goes beyond the usual pre and post service care already bundled into that procedure.
When it is not appropriate
Do not use 25 for the routine assessment that leads directly into a minor procedure, or just because the patient carries multiple diagnoses, if no separately identifiable, additionally documented evaluation and management work actually occurred that day.
CMS preference
No X modifier substitutes for 25 since it is specific to evaluation and management services; use 57 instead when the visit's real purpose was the decision to perform major surgery.
Retrieved 2026-07-18.
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