E/M and Modifier Strategy for 2026: How to Get Paid and Stay Compliant

Event Materials (Key Required)

In 2026, Evaluation and Management coding isn’t just about selecting the right level—it’s about how modifiers are applied, documented, and defended. Modifiers 25, 59, and 95 have become some of the most scrutinized billing elements across Medicare, Medicare Advantage, and commercial payers, driving both revenue loss and audit risk when used incorrectly. 

This session breaks down the 2026 E/M landscape and explains how to apply modifiers 25, 59, and 95 correctly—without triggering denials or payer reviews. We’ll clarify when an E/M service is truly “significant and separately identifiable,” how to support modifier 25 with compliant documentation, and when its use may be technically correct but strategically risky. We’ll also review modifier 59, focusing on distinct procedural services, NCCI edits, and common unbundling mistakes that lead to recoupments. 

Telehealth remains a major compliance challenge in 2026. We’ll address proper use of Modifier 95, place of service rules, and documentation requirements that impact reimbursement and audit exposure. 

Through real-world scenarios, attendees will learn how small coding decisions can significantly affect payment outcomes. By the end of this session, participants will have practical strategies to improve revenue, reduce denials, and build an audit-resistant E/M and modifier process for 2026. 

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Educational Objectives:

• Explain how the 2026 E/M coding framework shifts audit risk from level selection to modifier application and utilization patterns.
• Identify payer-specific enforcement trends related to modifiers 25, 59, and 95 across Medicare, Medicare Advantage, and commercial plans.
• Distinguish between compliant and high-risk use of modifier 25 by applying the “significant and separately identifiable” standard to same-day E/M and procedural services.
• Evaluate documentation elements required to support modifier 25 and recognize scenarios where its use may be technically correct but strategically risky.
• Apply modifier 59 appropriately by interpreting NCCI edits, determining when services are truly distinct, and avoiding common unbundling errors that lead to recoupments.
• Assess telehealth encounters for correct use of modifier 95, including place of service interactions and documentation requirements that affect reimbursement in 2026.
• Analyze real-world coding scenarios to determine how modifier decisions impact payment outcomes, denials, and audit exposure.
• Develop practical strategies to improve revenue integrity, reduce denials, and implement an audit-resistant E/M and modifier workflow for 2026

Areas Covered in the Session:

• 2026 E/M Coding Landscape
• Modifier 25: Compliance and Risk Management
• Modifier 59 and Distinct Procedural Services
• Telehealth and Modifier 95 in 2026
• Payer Enforcement and Audit Trends
• Real-World Coding Scenarios
• Revenue Optimization and Audit-Resistant Strategies
• Live Q&A Session

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Who Will Benefit:

• Healthcare IT leaders 
• Clinical informatics specialists 
• EHR administrators and analysts 
• Physician champions 
• Nursing leadership 
• Quality improvement professionals 
• Health information management staff 
• Practice administrators 
• Operations managers 
• Clinical workflow coordinators

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Presenter Biography:

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Additional Information:

System Requirement:

• Internet Speed: Preferably above 1 MBPS
• Headset: Any decent headset and microphone which can be used to talk and hear clearly

Live Course Cancellation Policy: If for any reason Skillacquire need to cancel this program, Skillacquire will notify participants by email of the cancellation no less than 24 hours prior to the expected start time.

Can’t Listen Live?

No problem. You can get access to an On-Demand webinar. Use it as a training tool at your convenience. For more information, you can reach out to the below contact:

Toll-Free No: 1-302-444-0162

Email: care@skillacquire.com

Purchase Order Form – Click Here to download PO form.

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