What Is The Difference Between Modifier -25 and -57 When Filing Medicare Medical Billing Claims?

What Is The Difference Between Modifier -25 and -57 When Filing Medicare Medical Billing Claims?

Modifier 25 and modifier 57 are sometimes difficult to differentiate between when doing medical billing. It is important to understand the differences between these two modifiers to ensure correct medical billing practices.

In medical billing Modifier 25 means when doing an evaluation and management, a physician decides a MINOR surgical procedure needs to be done on the same day. It means the evaluation and management should be paid for separately and not bundled with the surgical reimbursement.

In medical billing, Modifier 57 means when doing an evaluation and management, a physician decides a MAJOR surgical procedure needs to be done on the same day or the day after. This, like modifier 25, requires separate reimbursement for the E&M and for the surgery.

The difference is very slight between these two for medical billing. Modifier 25 is used in medical billing for minor procedures, while modifier 57 is used in medical billing for major procedures. The only other small difference is that modifier 57 could mean the surgery will be done the next day. Medically billing modifier 25 means the surgery will be done on the same day only.

There are several medical billing modifiers that have similar meanings, yet tell the insurance companies different stories. Medical billing firms make it their business to know the differences between these modifiers and use them in correct instances. Researching correct medical billing practices can take time and energy. It is very beneficial to use a medical billing firm to do this for you. They will ensure accurate claims with prompt payments.

There are so many modifiers out there that describe various current procedural terminology codes. Modifier 25 and 57 are commonly misunderstood. The difference is slight, but once understood, they are easy to differentiate.

View all Articles by: Kathryn Etienne, CCS-P