Modifier 25 for Preventative Evaluation & Management (E&M) Services, CR 32681

May 7, 2013

Effective 04/01/2013, MaineCare has elected to discontinue the use of the National Correct Coding Initiative edit modifier 25, when billing vaccine administration codes along with preventative E&M codes, as permitted by the Centers for Medicare and Medicaid Services (CMS). This includes CPT codes 99381 – 99397.

Please note how to submit claims and adjustments with the following dates of service:

  • 01/01/2013 through 03/31/2013- the modifier 25 needs to be included

  • 04/01/2013 through 12/31/2013- do not use modifier 25 for new claims

  • 04/01/2013 through 04/30/2013- claims previously submitted will be reprocessed and no provider action is needed