Monday, May 24, 2010

Modifier 27 - Multiple Outpatient Hospital Evaluation and Management Encounters on the Same Date

 Part - A  Level I Modifiers 27

Description Multiple Outpatient Hospital Evaluation and Management Encounters on the Same Date

Required for Claims Hospital Outpatient Prospective Payment System (OPPS)

Type of Bill: 13X

Coding Guidelines Modifier 25 should only be applied to the following HCPCS/CPT codes: 92002-92014, 99201-99499 and G0101 and G0175

General Guidelines

A. Hospitals may append modifier –27 to the second and each subsequent E/M code when more than one E/M service is provided to indicate that the E/M service is a separate and distinct E/M encounter from the service previously provided that same day in the same or different hospital outpatient setting.

B. Modifier –27 does NOT replace condition code G0 (zero). The G0 (zero) condition code should still be used in addition to the modifier –27 when there are multiple medical visits on the same day in the same revenue center but the visits are distinct and independent visits.

C. The use of modifier –27 must be supported by the documentation in the patient’s medical record.






SUBJECT: Use of Modifier –25 and Modifier 27 in the Hospital Outpatient Prospective Payment System (OPPS)

This Program Memorandum (PM) provides clarification on reporting modifier –25 and modifier –27 under the hospital OPPS.

The Current Procedural Terminology (CPT) defines modifier 25 as “significant, separately identifiable evaluation and management service by the same physician on the same day of the  procedure or other service.” Modifier –25 was approved for hospital outpatient use effective June 5, 2000.

The CPT defines modifier –27 as “multiple outpatient hospital evaluation and management encounters on the same date.” HCFA will recognize and accept the use of modifier –27 on hospital OPPS claims effective for services on or after October 1, 2001. Although HCFA will accept modifier –27 for OPPS claims, this modifier will not replace condition code G0. The  reporting requirements for condition code G0 have not changed. Continue to report condition code G0 for multiple medical visits that occur on the same day in the same revenue centers.

For further clarification on both modifiers, refer to the CPT 2001 Edition. Below are general guidelines in reporting modifiers –25 and –27 under the hospital OPPS.


E/M Modifiers - Modifier 27

• Multiple E/M encounters on same calendar day

• OPPS status indicator “V” (clinic or emergency department visit)

• Modifier is appended to second or subsequent E/M

• Condition code is required if E/M is in same revenue center on same day

• Regulatory scrutiny


Usage example

• 99213 Established patient, moderate clinic visit

• 99283-27 Moderate complexity

Effective August 1, 2015, if there are multiple Evaluation and Management (E/M) claims on the same day and the second one does not have a modifier 27 “Multiple Outpatient Hospital E/M Encounters on the Same Date”, the detail will deny with EOB code 5500 “Cannot have Multiple E/M Claims on the Same Date of Service”. Modifier 27 should be appended only to the following E/M codes: Procedure codes 92002-92014 and 99201-99499, and Healthcare Common Procedure Coding System (HCPCS) codes G0463 and G0380- G0384, when they are billed in connection with Revenue Center Codes (RCCs) 45X, 51X or 981.



If there are multiple Evaluation and Management (E/M) claims on the same day and the second one does not have a modifier 27 “Multiple Outpatient Hospital E/M Encounters on the Same Date”, the detail will deny with EOB code 5500 “Cannot have Multiple E/M Claims on the Same Date of Service”.

If on an outpatient claim the hospital fails to bill condition code G0 when modifier 27 is used to identify a distinct/separate E/M encounter performed for the same department (i.e. RCC 450/456 emergency room department), on the same date of a separate encounter, then the claim will deny with the following EOB codes:


5501 - “Condition Code G0 Required when Modifier 27 Billed with an E/M Code” on a current claim or

 5502 - “Previous Claim Required Condition Code G0 when E/M Code is billed with Modifier 27” if the previous claim had a modifier 27, but failed to bill with condition code G0.


Modifier 27  Invalid Combination  Special Coding Instructions

 Modifier 27 is used to identify multiple outpatient hospital E&M encounters on the same date. This modifier is not to be used by physician practices. It was created exclusively for hospital outpatient departments.

For hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct E&M encounters performed in multiple outpatient hospital settings on the same date can be reported by adding modifier 27 to each appropriate level outpatient and/or emergency department E&M code(s).

This modifier cannot be used for physician reporting of multiple E&M services performed by the same physician on the same date. This modifier is valid for the following CPT® code ranges: 99201 – 99239, 99241 – 99255, 99281 – 99299.





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