General Question for the Week of September 3, 2018

General Compliance Question of the Week

Question:

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

Answer:

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 https://www.racmonitor.com/cms-proposes-50-percent-reduction-in-claims-submitted-with-modifier-25.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.