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Modifiers

Modifiers

Modifier 25 billing

Modifier 25: How to Use It Correctly, Avoid Denials, and Protect Practice Revenue

What Modifier 25 Means (And Why It Matters for Your Practice) Modifier 25 tells payers you provided a significant, separately identifiable Evaluation & Management (E/​M) service on the same day as a minor procedure. According to CMS and CPT® guidance, the evaluation normally required before a minor procedure is already included in the procedure payment, […]
Published Date: March 11, 2026
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Modifier 25 billing

How to Protect Revenue When Billing E/M Services with Preventive Visits

If your providers are seeing patients for Annual Wellness Visits (AWVs) or preventive exams and addressing new or worsening problems at the same visit, you face a critical billing question: Can you bill an E/​M service with Modifier 25 — or will it trigger a denial or audit? Under the CPT® Evaluation and Management guidelines, […]
Published Date: February 25, 2026
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Are Revenue Cycle Bottlenecks Costing Your Practice Thousands?

Dr. Lopez’s busy orthopedic practice submits hundreds of claims every week. But with denials creeping up, the billing team is constantly resubmitting claims. One front-desk employee, unfamiliar with payer rules, keeps entering incomplete patient insurance data—forcing staff to chase patients for missing information. Meanwhile, credentialing delays keep a new physician from being properly enrolled with […]
Published Date: July 24, 2025
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Telehealth modifiers

3 Telehealth Modifiers You’ll Need to Collect Max Revenue

Not every code you submit to Medicare requires a modifier, which is why it can sometimes be easy to forget them. Unfortunately, leaving telehealth modifiers off of some claims can cause instant denials, which is why it’s essential to iron out the rules of when you need them and when you don’t. Check out three […]
Published Date: May 19, 2025
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GA modifier

3 Tips to Comply With UHC’s New GA Modifier Policy

Anyone who’s ever filled out an advance beneficiary notice (ABN) for a Medicare patient knows what the GA modifier is. This modifier tells Medicare payers that an ABN is on file for a service that the insurer doesn’t cover. And as of February 1st, it will also do the same for UnitedHealthcare (UHC) commercial plans. […]
Published Date: January 27, 2025
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RT and LT modifiers

Real-World Examples Guide When to Use RT and LT Modifiers

If you’ve ever coded a patient chart, you know about the LT (Left side) and RT (Right side) modifiers. Together, the RT and LT modifiers are used to show laterality — in other words, they describe which side of the body was addressed during a procedure or surgery, or if supplies are being prescribed. Check […]
Published Date: January 2, 2024
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Modifier 25

3 Modifier 25 Best Practices to Keep Your E/M Pay Flowing

Every minor procedure your providers perform includes an inherent evaluation and management (E/​M) portion factored into the reimbursement for it. But when you go beyond that cursory E/​M work, you should be able to collect for the extra time your provider spends — and that’s where modifier 25 comes in. Although modifier 25 represents a […]
Published Date: November 28, 2023
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CPT modifiers

3 Ways Payers Are Monitoring Your Use of CPT Modifiers

Without CPT modifiers, many coders would struggle to submit accurate claims to payers. Why? Because modifiers allow you to provide insurers with more information about a service or supply, without changing the meaning of the code they’re modifying. In many cases, modifiers can be the difference between a denial and a claim approval. Coders have […]
Published Date: October 23, 2023
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Modifier 59

4 Uses of Modifier 59 That Are Appropriate (And 2 That Aren’t)

Whether or not you have a solid understanding of the National Correct Coding Initiative (NCCI) edits, you are likely very familiar with modifier 59 and the X modifiers, which allow you to report two procedures at the same time. What many practices don’t know, however, is that payers are waiting for you to misuse these […]
Published Date: July 26, 2023
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Modifier 25

Cigna Delays Plan Requiring Medical Records With Modifier 25

UPDATE: Cigna has delayed the requirement described below, and it will no longer take effect on May 25. The company has not yet indicated when it will go into place, so keep an eye on the Healthcare Training Leader website for more information as this story develops. When you perform a minor procedure along with […]
Published Date: May 23, 2023
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