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South Carolina Healthy Connections

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Reimbursement Policy Update: Modifier 25

January 09, 2019

Policy Update
Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service

(Policy 06-003, effective 04/01/19)

The Modifier 25 reimbursement policy for Healthy Blue provides the criteria for reimbursement for a significant, separately identifiable evaluation and management (E&M) service performed by the same provider on the same day of the original service or procedure. Effective April 1, 2019, Healthy Blue does not allow separate reimbursement for E&Ms performed on the same day as a major surgery (90-day global period).

For more information, please refer to the Modifier 25 reimbursement policy by visiting and selecting Providers.

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