Modifier 25: Significant, separately identifiable E/M service on the same day as a procedure

Modifier Code

Code Type

Billing modifier

When to Use Modifier 25

Use modifier 25 when a significant, separately identifiable evaluation and management (E/M) service is performed by the same provider on the same day as a procedure. In psychiatry and integrated care settings, this applies when a physician or prescriber conducts a distinct E/M visit in addition to a therapy procedure. The E/M must be above and beyond what is inherent to the procedure itself.

CPT Codes Commonly Paired with Modifier 25

These CPT codes are frequently billed alongside modifier 25 in therapy practice:

CPT 99213 - Office or outpatient visit, moderate complexity CPT 99214 - Office or outpatient visit, high complexity CPT 90833 - Psychotherapy add-on, 30 minutes with E/M CPT 90836 - Psychotherapy add-on, 45 minutes with E/M CPT 90838 - Psychotherapy add-on, 60 minutes with E/M

Superbill Notes for Modifier 25

What to include: Include separate documentation for the E/M service and the procedure. The superbill should reflect distinct diagnoses or clinical decision-making for each billed service.

Adding Modifier 25 to a Superbill

Superbilled lets you add modifier codes directly to each line item on your superbill. When generating a superbill with modifier 25, make sure to include your NPI number, the patient's diagnosis code, date of service, fee charged, and amount paid. The modifier appears alongside the CPT code on the claim.

Generate a superbill with Modifier 25 free