I am doing an audit on modifier 25 use and came across a finding that the PCP is adding modifier 25 to the E&M when x-rays are done the same DOS. I have been told that it was due to them both billing under the same TIN. I always believed that the modifier is only needed (per CCI) if the service is by the same TIN AND Specialty. I would appreciate any feedback, as we definitely don’t want to bill with an unnecessary 25 modifier.

TIA,
Shelly L. Kubacki, BS, MPA, CPC, CPMA