Coding and Payment Guidelines/Modifiers 

Effective, 1 de enero de 2025, modifier 27 has been added to this payment policy. Modifier 27 is used to indicate multiple outpatient hospital evaluation and management (E/M) encounters on the same date. This modifier helps distinguish separate and distinct E/M services provided by different departments in the same hospital. Modifier 27 only applies to Hospital facility claims (POS 22). 

Modifier 27 may be appended to the following CPT codes only:

                Evaluation and Management (E/M) Codes specific to outpatient settings, including:

• 99202–99215: Office or other outpatient visits (new or established patients).
• 99281–99285: Emergency department visits.
• G0463: Hospital outpatient clinic visit for assessment and management of a patient.

                Observation Services:

• 99217–99220: Initial and subsequent observation care.
• 99224–99226: Subsequent observation care.

For additional details related to this policy, please click here.