What is modifier 25 and when should I use it?

Modifier 25 indicates a significant, separately identifiable E/M service performed on the same day as a procedure. Use it when evaluation goes beyond what's included in the procedure. The E/M must be distinct from the pre/post work of the procedure and documented separately with its own HPI, exam, and MDM.

How do I document to support modifier 25?

Document a separate chief complaint or distinct component of the visit, separate history and examination, independent medical decision making, and a separately documented assessment and plan. The E/M note should stand alone as a billable service even without the procedure.

What is the difference between modifier 59 and XE/XS/XP/XU?

Modifier 59 indicates distinct procedural service. CMS prefers the more specific X modifiers: XE (separate encounter), XS (separate structure), XP (separate practitioner), XU (unusual non-overlapping service). Use X modifiers when they apply; use 59 only when no X modifier is appropriate.

When should I use modifier 24 vs modifier 79?

Use modifier 24 for an unrelated E/M service during the postoperative period of a previous surgery. Use modifier 79 for an unrelated procedure during the postoperative period. Both require documentation that the service is unrelated to the original surgery.

What documentation supports modifier 57 for decision for surgery?

Modifier 57 applies to E/M visits where the decision to perform major surgery (90-day global) is made. Document the clinical presentation, diagnostic workup, treatment options discussed, risks/benefits of surgery, and the decision-making process leading to surgical recommendation.

Modifier Documentation Guide — CPT Billing Modifiers

Administrative All Specialties Updated: 11/26/2025

The Modifier Documentation Guide helps physicians and medical billers understand when and how to use CPT modifiers for accurate reimbursement. This comprehensive guide covers the most common modifiers including modifier 25 (significant, separately identifiable E/M), modifier 59 (distinct procedural service), modifier 24 (unrelated E/M during postoperative period), and modifier 57 (decision for surgery). Each modifier includes documentation requirements, appropriate use examples, and common errors to avoid. Understanding modifier usage prevents claim denials, ensures appropriate reimbursement, and maintains compliance with payer policies.

Modifier Documentation Guide

Modifier 25: Significant, Separately Identifiable E/M

When to Use

E/M goes beyond usual pre/post work of procedure
Patient has separate, distinct problem requiring evaluation
E/M would be billable even without the procedure

Documentation Requirements

1. Separate chief complaint (can be related but distinct)
2. Distinct history and examination
3. Independent medical decision making
4. Separate assessment and plan

Example

Patient for mole removal + chest pain evaluation
Bill: Skin lesion removal + 99214-25

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Modifier 59: Distinct Procedural Service

X Modifiers (Preferred)

Modifier	Use When
XE	Separate encounter
XS	Separate structure
XP	Separate practitioner
XU	Unusual non-overlapping

When to Use

Different anatomic site
Different session/encounter
Distinct procedure otherwise bundled

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Modifier 24: Unrelated E/M During Postop Period

When to Use

Patient within global surgical period (10 or 90 days)
E/M visit for unrelated condition
Document shows unrelated nature

Documentation

State: "Patient within [X]-day global for [procedure]. Today's visit for [unrelated condition], distinct from postoperative care."
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Modifier 57: Decision for Surgery

When to Use

E/M where major surgery decision is made
Only for major surgery (90-day global)
Use modifier 25 for minor surgery (10-day global)

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Quick Reference

Scenario	Modifier
E/M same day as procedure	25
Separate procedure sites	59 or XS
E/M during postop (unrelated)	24
Procedure during postop (unrelated)	79
Decision for major surgery	57
Repeat procedure same physician	76
Bilateral procedure	50

Modifier Documentation Guide — CPT Billing Modifiers

Template

Modifier Documentation Guide

Modifier 25: Significant, Separately Identifiable E/M

When to Use

Documentation Requirements

Example

Modifier 59: Distinct Procedural Service

X Modifiers (Preferred)

When to Use

Modifier 24: Unrelated E/M During Postop Period

When to Use

Documentation

Modifier 57: Decision for Surgery

When to Use

Quick Reference

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