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Modifiers 25 and 57: Appropriate use – Ophthalmic Professional

Modifiers 25 and 57 are office-based CPT modifiers; they apply to claims when an office visit and surgery happen in close proximity to one another (the same day or following day). They are often confused with one another but differ in significant ways.

Knowing the circumstances when they might apply is crucial to understanding their appropriate use. Additionally, modifier 25 has been placed on the Office of the Inspector General’s (OIG) Annual Work Plan for the past few years, so it is getting increased scrutiny.

This article addresses the following topics:

  • Use of modifier 57
  • Use of modifier 25

This article was published in Ophthalmic Professional’s Coding column, and written by Corcoran’s Senior Consultant, Paul Larson, COE. To view the entire article in Ophthalmic Professional, click on the link below:

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