Which Evaluation and Management (E/M) code requires modifier -25?

The necessity for using modifier -25 is linked to the specific circumstances surrounding the Evaluation and Management (E/M) service provided. Modifier -25 is used when a significant, separately identifiable E/M service is performed on the same day as another procedure.

In the context of E/M codes, certain codes like 99213 typically represent a level of service that may necessitate a modifier if the patient requires additional evaluation or management beyond the normal service associated with that code. When using 99213, if the clinician performs a procedure during the same visit that is distinct from the E/M service, modifier -25 would indicate that the E/M service was separate and warranted its own billing.

This is particularly important for accurate billing and compliance, as it clarifies to payers that the E/M service and the procedure are distinct, ensuring appropriate reimbursement for the services rendered. The other codes listed, while also representing E/M services, may not consistently require the modifier in typical scenarios where the services are bundled or not separately identifiable. Thus, 99213 is often the choice that utilizes modifier -25 to delineate separate services on the same date of service.