Cardiology. Modifier 25: When a Separate E/M Is Defensible — and When It Is Not

Section analysis by Tatyana Kantor, Billing Department, WCH

Editorial note: This article draws on CPT and CMS Medicare Claims Processing Manual guidance on Modifier 25, HHS Office of Inspector General audit and Work Plan reporting, the CY 2027 Medicare Physician Fee Schedule proposed rule, and cardiology-specific coding commentary, current through August 2026. It is for informational and educational purposes only and does not constitute legal, coding, or compliance advice. Payer-specific requirements should be verified against the current CPT manual and payer policy before billing.