How to Use Modifier 25

January 8, 2026
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Coding and Billing

Modifier 25 allows for a same-day procedure to be reported along with an E/M service, such as a consult note.

It’s a niche modifier, but can mean the difference between being reimbursed for a consult and not, if the consult occurs on the same date of a procedure, as it does for many proceduralists.

The modifier requires the following of the consult:

  • It must be separately identifiable from the procedure, and
  • It must be medically necessary
Modifier 25, Significantly, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure of other service

To code it, append the modifier to the E/M service (i.e., the consult note) and not to the procedure code.

The note itself should include details beyond the standard meet-and-greet or pre-procedure H&P, the latter of which is considered incidental to the work of the procedure and not worthy of being reported separately. Likewise, the note should include a change in assessment and plan, or otherwise something more than a brief interim history.*

So, is it worth it?

For most proceduralists, I think the answer is yes. Even moreso if you see a lot of consults for same day procedures, as might a gastroenterologist or interventional radiologist.

Here’s an example:

A patient is seen for consultation for ascending cholangitis, and a decision is made to perform an ERCP on the same day. The E/M service is reported with modifier 25 appended and the ERCP is reported without a modifier.

For proceduralists, it adds incremental value that accumulates over the course of time. Considering most same-day procedures are, well, acute (and thus, high-risk), one can expect to add an additional 3.50 to 7 RVUs per call shift (the work RVU value of 1-2 high level consult notes).

On average, that can come out to ~$15,120 over the course of a year.

Keep in mind, the consult note must be, well, a full consult note. Meaning, it should incorporate a fleshed out assessment and plan, and not be a regurgitation of a previous day's progress note, if no changes in the clinical plan have occurred. Interim histories (such as before performing an endoscopy) are considered part of the procedure and not billed separately.