Modifier 25 and Audiograms

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March 3, 2016

Question:
When I bill an E/M code such as, a new patient or established patient visit, do I need to append modifier 25 when I also bill for an audiogram?

Answer:
No, not for Medicare claims. Modifier 25 is appended to the E/M code to show your service is above and beyond that which is included in the minor procedure (0 or 10 days) performed on the same day. Medicare does not consider an audiogram (92557) to have a global period since it is a diagnostic test. Therefore, modifier 25 is not needed on the E/M code.

*This response is based on the best information available as of 03/03/16.