Information About Modifier 25 and Coding

Information and guidance regarding three extremely active payment and compliance issues:

1. Audit requests regarding OMT services reported on the same date of service as an office visit, along with the use of the Modifier-25.

2. Audit requests related to coding higher level Evaluation and Management (E/M) services; often linked to the increase in use of electronic health records, and;

3. Pay-for-performance and other quality recognition programs requirements for physicians to justify any practices that may cause them to be considered practice (cost) outliers.




AOA Letter regarding audits and Modifier 25 -


AOA Position Paper on Evaluation and Management Services with OMT

revised July 2006


CMS-Trailblazer audit tool –


Medicare-Modifier 25 Use –


November 2011 Federal Register pages –


Coding Trends of Medicare Evaluation and Management Services

US Department of Health & Human Services

Office of Inspector General report (OEI-04-10-00180)