Modifier-25 — Unbundled E/M on the Same Day as a Procedure

AHCIP GR 1.4. When a same-day E/M is billed alongside a procedure (e.g. office visit + joint injection, or office visit + chest X-ray), the E/M must carry modifier-25 to indicate it is a separately-identifiable service. Without modifier-25, AHCIP bundles the E/M into the procedure and pays only the procedure. Zorva's rule AH-MOD-25 is the highest-yield catch — modifier-25 gaps are the most common denial pattern in Alberta family-medicine claims.