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Here is some helpful information for using modifiers 25, 51 and 79.
- Modifier 25 should only be appended to Evaluation and Management (E&M) codes. No other usage of this modifier is appropriate when appended to any other CPT codes. It should only be used when the E&M service is a separate and significant service from the procedure performed on the same day. It should not be used in an attempt to bill two E&M services on the same date.
- Modifier 51 is appended to indicate multiple procedures performed on the same date of service. This modifier may be appended but is not required as our claims processing system is configured to apply multiple procedure reductions per the South Carolina Department of Health and Human Services guidelines. It is appropriate to use on surgical, radiology and medicine code sets. It should not be used with add-on codes identified with a “+” or modifier 51 exempt codes indicated by “ Ø “ in the CPT book.
- Modifier 79 is appended to surgery and medicine CPT codes. It indicates that the current procedure performed during the post-operative period is unrelated to the original procedure. Select Health follows the South Carolina Medicaid global period guidelines of 30 days. This modifier should not be used in any other circumstances. It should not be appended to E&M services and is not appropriate when other procedures are performed on the same date. There are other modifiers indicated for these situations.
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