5 Key Takeaways

• 1

  Between June 2022 and May 2023, Medicare reimbursed 3.3 million intravitreal injections and 1.4 million E/M claims with modifier -25.

• 2

  The OIG found that 92% of claims reviewed did not meet the requirements for modifier -25, indicating high error rates in its application.

• 3

  CMS has updated guidance emphasizing that modifier -25 should only be used for significant, separately identifiable E/M services.

• 4

  Documentation must clearly support a distinct E/M service to justify the use of modifier -25, as routine evaluations do not qualify.

• 5

  Practices are encouraged to conduct internal reviews and provide education on the appropriate use of modifier -25 to ensure compliance.