New York
Provider Communications
Update regarding Evaluation and Management with modifier 25 same day as procedure when a prior E/M for the same or similar service has occurred (Professional)
Beginning with claims processed on or after September 1, 2019 Empire may deny the E/M service with a modifier 25 billed on the day of a related procedure when there is a recent service or procedure for the same or similar diagnosis on record.
If you believe a claim should be reprocessed because there are medical records for related visits that demonstrate an unrelated, significant, and separately identifiable E/M service, please submit those medical records for consideration.
Featured In:
August 2019 Empire Provider News