Modifier 24 — Unrelated Evaluation & Management Service in the Post-Operative Period
Defines when Premera recognizes Modifier 24 for evaluation and management (E&M) or eye exam services provided by the same physician during a postoperative global surgical period and applies to Premera and affiliated lines of business.
No material clinical or coverage changes in this revision.
Criteria for Recognizing Modifier 24
Modifier 24 coverage criteria
Covered when ALL of the following are met:
ALL of the following
- Service is an evaluation and management (E&M) or eye examination provided during the postoperative global surgical period of a major or minor procedure (10- or 90-day period).
- Service was provided by the same physician or other qualified healthcare professional as determined by the provider Taxonomy/Tax ID number.
- The submitted diagnosis code demonstrates the E&M or eye exam is unrelated to the original surgical procedure.
- The medical record sufficiently documents that the visit was unrelated to the condition that initially required the original surgical procedure.
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