KZA Alerts

A new Office of Inspector General (OIG) report is shining a spotlight on the use of Modifier 25 in dermatology, and the findings have implications far beyond a single specialty. In this KZA Alert, we review the OIG’s concerns regarding documentation, E/M leveling, and improper use of Modifier 25, including an estimated $62.9 million in Medicare overpayments tied to same-day E/M services and minor procedures.

We discuss when Modifier 25 is appropriate, the most common compliance pitfalls identified by the OIG, and practical steps providers and coding teams can take to reduce audit risk. Whether you're in dermatology, orthopedics, ENT, general surgery, or another procedural specialty, this episode serves as an important reminder that Modifier 25 should be supported by clear documentation, medical necessity, and a truly distinct evaluation service.

MLN Connects Newsletter for May 28, 2026