Forum - Questions & Answers
E/M visit and flu shot same day.. modifier 25?
Refresh my memory. Does Medicare require a mod 25 on the flu shot/admin code if the patient had a regular office visit on the same day? Seems to me they said yes and then said no. I've looked on local carriers sight and CMS, no real answer. Anyone had denials for 2009/2010 flus season yet?
thanks
nope
we never use it
Flu shot and modifier
You only need modifier 25 when a procedure is done on the same day as an E/M. These are mostly surgical procedures, but there are some in the medicine section, as well.
The payers have confused us by not following CPT rules and requiring it at times when they shouldn't! But, then the OIG and CMS tell us not to overuse the modifier.
modifier 25
I work for a physician in Maryland and one in California. I always attach a 25 onto the visit when it is done with a flu shot. If there is no modifier they will deny the office visit and just pay the flu shot.