E&M 99213 + Urine pregnancy test 81025
Urine pregnancy test (POC) and office E&M can be reported together — 81025 is separately payable.
Why this pair bundles
Point-of-care lab is separately payable when distinct from the encounter purpose.
Modifier-bypass policy
Modifier indicator: 1 — modifier 59 / XE / XP / XS / XU permitted when supporting documentation is on file.
Generally separately reportable. No modifier needed in most cases.
Documentation requirements
- Document pregnancy test result
- Note clinical indication
Common clinical scenarios
- Women's health visit with pregnancy screening
- ER visit for abdominal pain in reproductive-age woman
Frequently asked questions
Why does CMS bundle 99213 and 81025?
Point-of-care lab is separately payable when distinct from the encounter purpose.
When can I use modifier 59 (or X{EPSU}) to bypass?
Generally separately reportable. No modifier needed in most cases.
What documentation supports separate billing?
Document pregnancy test result; Note clinical indication.
When does this conflict typically arise?
Women's health visit with pregnancy screening; ER visit for abdominal pain in reproductive-age woman.
Related NCCI edits
- E&M 99213 + RPM treatment management (0780T equivalent)Remote physiologic monitoring services and same-day E&M generally do NOT bundle
- E&M 99213 + Joint injection 20610E&M and major joint injection (knee, shoulder, hip) bundle without modifier 25 o
- E&M 99213 + Venipuncture 36415Office E&M and routine venipuncture can be reported together — 36415 is separate
- E&M 99213 + Vaccine admin 90471E&M 99213 and vaccine administration 90471 bundle without modifier 25 on the E&M
- E&M 99213 + ECG 93000Office E&M and complete ECG can be reported together but require modifier 25 on
- E&M 99213 + Pressurized inhalation (94640)E&M and nebulizer treatment bundle without modifier 25 on the E&M.
Sources
Catch NCCI 99213/81025 conflicts before submission
ApprovalHelp auto-flags NCCI bundling conflicts on the claim line before you submit. Modifier-bypass eligibility checked against current quarterly NCCI tables. no setup fee.
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