In 2019, the OIG performed an audit of claims that were billed by podiatrists for E/M services. The audit examined whether podiatrists’ claims for E/M services billed with the 25 modifier, which indicates that the E/M service was significant and separately identifiable from a minor surgical procedure billed on the same date of service, one that has a postoperative global period of 0 or 10 days, complied with Medicare’s guidelines. One hundred (100) claims were sampled, and it was found that forty-four (44) claims did not comply with Medicare’s guidelines. The OIG estimated that $39.6 million of the $222.5 million paid by Medicare during the audit period was inappropriate. It was found that during the audit period, CMS’s oversight may not have been sufficient to prevent improper payments.
The OIG recommends that CMS work with the Medicare Administrative Contractors (ie. MACs) to determine whether additional oversight is necessary to prevent improper payments associated with podiatrists’ billing of E/M services with the 25 modifier appended. Once again, the improper payments amounted to an estimated $39.6 million during the audit period. CMS concurred with the recommendation of the OIG.
This audit was performed based upon the fact that in 2010, the OIG found that Medicare inappropriately paid $6.7 billion for E/M services that were incorrectly coded or were insufficiently documented. Since the OIG had not reviewed podiatry services since 2002, the 2019 audit was performed in order to determine if the issues that were identified in the 2010 report existed for payments to podiatrists for E/ services performed from January 1 – December 31, 2019. The bottom line is to determine whether or not podiatrists’ claims for E/M services complied with Medicare requirements.
When the claims were audited, it was found that the only issue with respect to the E/M service was not that the E/M service was appended by the 25 modifier and the E/M service was not significant and separately identifiable from the minor surgical procedure that was performed on the same date of service. Additionally, it was found that there were insufficiently documented services and that there were also incorrectly coded E/M services.
On October23, 2025, Dr. Mehmet Oz the Administrator for the Centers for Medicare and Medicare Services sent a correspondence to Carla J. Lewis, the Acting Deputy Inspector General for Audit Services, Office of Inspector General. The Subject was the following: Office of Inspector General (OIG) Draft Report: Podiatrists’ Claims for Evaluation and Management Services Did Not Comply With Medicare Requirements (A-09-22-03012).
The OIG recommends that the Centers for Medicare and Medicaid Services work with the MACs to determine whether additional oversight (eg. guidance, education, medical reviews, and/or provider internal audits) is necessary to prevent improper payments associated with podiatrists’ billing of E/M services with modifier 25, which amounted to an estimated $39,583,052 for the audit period.
For years I have opined that the number 1 reason that podiatrists are audited and fail the audit is for the inappropriate use of the 25 modifier. Well, it is no longer my opinion. It is fact.
Michael G. Warshaw, DPM, CPC
Source of information: HHS Office of Inspector General
Report Highlights
December 2025/ A-09-22-03012
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