When billing for OMT, the evaluation and management (E&M) code must be followed by which modifier?

When billing for OMT, the evaluation and management (E&M) code must be followed by which modifier?

• A. -25 modifier
• B. -59 modifier
• C. -24 modifier
• D. No modifier

Answer: (A)

When you bill for an osteopathic manipulative treatment on the same day as an evaluation and management visit, you need to signal that two distinct services were provided. The E/M service is significant and separately identifiable from the OMT procedure, so you attach modifier -25 to the E/M code. This tells the payer that the E/M care is an additional, separate service beyond the OMT. If you didn’t use a modifier, the payer might bundle the E/M into the OMT payment and reduce or deny separate E/M reimbursement. The other modifiers don’t fit this situation: -24 is for an unrelated E/M during a postoperative period, and -59 is used to indicate a distinct procedure when two procedures would normally be bundled. No modifier would fail to indicate that the E/M was a separate service on the same day as the OMT. So, the correct approach is to append -25 to the E/M code.

When you bill for an osteopathic manipulative treatment on the same day as an evaluation and management visit, you need to signal that two distinct services were provided. The E/M service is significant and separately identifiable from the OMT procedure, so you attach modifier -25 to the E/M code. This tells the payer that the E/M care is an additional, separate service beyond the OMT.

If you didn’t use a modifier, the payer might bundle the E/M into the OMT payment and reduce or deny separate E/M reimbursement. The other modifiers don’t fit this situation: -24 is for an unrelated E/M during a postoperative period, and -59 is used to indicate a distinct procedure when two procedures would normally be bundled. No modifier would fail to indicate that the E/M was a separate service on the same day as the OMT.

So, the correct approach is to append -25 to the E/M code.