CurrentPremera BluecrossPolicy N/A

Modifier 24 — Unrelated E&M Service by the Same Physician

Defines when Premera recognizes and will reimburse evaluation & management (E&M) or eye exam services appended with modifier 24 when provided by the same physician or qualified healthcare professional during a postoperative global surgical period; applies to Premera entities and affiliated plans and affects providers submitting CMS-1500/837P claims.

Policy Summary

PayerPremera Bluecross

PolicyModifier 24 — Unrelated E&M Service by the Same Physician

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateFeb 4, 2025

Key ActionAppend modifier 24 to an E&M or eye exam CPT code to indicate an unrelated E&M service during the postoperative global surgical period when documentation and diagnosis support that the visit is unrelated to the original surgical procedure.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

99201-99499; 92002-92004; 92012-92014E&M and eye exam code ranges referenced

10- or 90-dayPostoperative global surgical periods specified

Multiple entitiesOrganizational scope

Annual through 02/04/25Policy review history

Coverage Criteria for Modifier 24

Modifier 24 coverage criteria

Covered when ALL of the following are met:

ALL of the following

ALL of the following
- ALL of the following
  - Eligible code: E&M or eye exam CPT code in ranges 99201-99499, 92002-92004, or 92012-92014 with modifier 24 appended.
  - Timing: Service occurs during the postoperative global surgical period (10- or 90-day).
  - Unrelated diagnosis: The diagnosis code submitted with the E&M or eye examination must clearly show the service was unrelated to the original surgical procedure.

Policy Summary

PayerPremera Bluecross

PolicyModifier 24 — Unrelated E&M Service by the Same Physician

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateFeb 4, 2025

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider Billing Actions and Documentation

Billing Rule

When to append modifier 24

Append modifier 24 to an E&M or eye examination CPT code (CPT 99201-99499, 92002-92004, 92012-92014) to indicate an unrelated E&M/eye exam provided by the same physician or other qualified healthcare professional during the postoperative global surgical period (10- or 90-day). The submitted diagnosis must clearly show the visit is unrelated to the original surgical procedure, and the member’s medical record must sufficiently document that the visit was unrelated.

Do not append modifier 24 for visits related to surgical complications or infection that do not require return to the OR.
Do not append modifier 24 for removal of sutures or other wound treatment included in the global surgical package.
Do not append modifier 24 for services on the same date as the surgical procedure, routine postoperative exams, or services outside the postoperative period.

Key Definitions

Modifier 24 — Unrelated Evaluation & Management Service by the Same Physician

DefinitionModifier 24 — Unrelated Evaluation & Management Service by the Same Physician: a modifier appended to an E&M or eye examination CPT code to indicate the service was unrelated to the original surgical procedure when performed during the postoperative global surgical period.

When to useAppend to an E&M or eye exam CPT code (CPT 99201-99499, 92002-92004, 92012-92014) to indicate an unrelated E&M service provided by the same physician or other qualified healthcare professional (based on provider taxonomy/Tax ID).

Documentation requiredSubmitted diagnosis must clearly show the E&M/eye exam was unrelated to the original surgical procedure and medical record documentation must support that the visit was unrelated.

Not appropriate whenDo not append for visits related to surgical complication or infection that do not require return to the OR, removal of sutures or wound care (part of the global package), services on the same date as surgery, or routine postoperative exams.

Postoperative global surgical period

DefinitionPostoperative global surgical period — the predefined 10- or 90-day timeframe after a procedure during which routine postoperative care is included in the global surgical package.

Applies toMajor and minor procedures with either a 10- or 90-day postoperative period; modifier 24 may be used for unrelated E&M/eye exam services occurring within these periods.

Included careRoutine postoperative visits, removal of sutures, wound care, and services related to surgical complications that do not require return to the OR are considered part of the global package and are not separately reported with modifier 24.

OpenPayer

Modifier 24 — Unrelated E&M Service by the Same Physician

Coverage Criteria for Modifier 24

Eligible Codes and Coding Guidance

Provider Billing Actions and Documentation

Key Definitions

99201-99499	Evaluation & Management CPT codes
92002-92004	Eye exam technical/diagnostic codes
92012-92014	Eye exam codes