US · guidance
CMS Pub. 100-04, ch. 18, § 80.3.3
Outpatient Prospective Payment System (OPPS) Hospital Billing
Hospitals subject to OPPS (TOBs 12X and 13X) must use modifier -25 when billing the IPPE G0344 along with the
technical component of the EKG, G0367, on the same claim. The same is true when billing IPPE code G0402 along
with the technical component of the screening EKG, code G0404. This is due to an OPPS Outpatient Code Editor
(OCE) which contains an edit that requires a modifier -25 on any evaluation and management (E/M) HCPCS code if
there is also a status “S” or “T” HCPCS procedure code on the claim.
History
(Rev. 2159, Issued: 02-15-11, Effective: 01-01-11, Implementation: 04-04-11)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
2a73fb92f3cd899563826fcd562b92fdda100cf670610aafa49236a1389c3154
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