Modifier 24, Unrelated E/M service

Page last updated on: 8/28/25

This modifier may be used to indicate that an evaluation and management (E/M) service performed within the post-operative period (the global period of a major or minor surgery, which can range from 0 to 90 days) is unrelated to the prior procedure.

Note: Unlike under Medicare, Priority Health does not treat providers within the same specialty as a single physician. Claims are processed and clinical edits applied by each rendering physician.

Correct use of Modifier 24

  • Visit for a new problem unrelated to the procedure 

  • Visit for treatment of the underlying condition that prompted the procedure 

  • Visit for treatment of complications, exacerbation or recurrence 

  • The E/M service is for the treatment of a problem unrelated to the procedure (supported by a different ICD-10 code) 

Note: a different diagnosis code will not automatically bypass any clinical edits Priority Health has in place related to E/M services performed in the post-operative period.   

Incorrect use of Modifier 24

  • The service is not performed during the global period 

  • A different physician conducts the service 

  • The service is related to the original procedure 

  • The modifier is appended to critical care codes 99291 or 99292
     

Resources

Modifier 24 Fact Sheet (WPS)