# Cigna 25 modifier policy



## Shauswald (May 23, 2022)

Received a letter from Cigna today stating effective 8/13/22 they will be requiring a chart note with every claim that a 25 modifier is used.    Wondering if other insurances will follow suit?


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## OpenClaims (May 23, 2022)

What do they mean exactly by a 'chart note'? If they're referring to reported an encounter with a separate E/M with appended modifier 25. Example: 99215-25, 99396. Some payors are not wanting to pay for the supported separate E/M, so this may be their way of trying to get around that. I know that BCN is not wanting to pay for these.


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## hondriezek (May 24, 2022)

Shauswald said:


> Received a letter from Cigna today stating effective 8/13/22 they will be requiring a chart note with every claim that a 25 modifier is used.    Wondering if other insurances will follow suit?


Our office has received the same letter stating that they will require documentation to support a minor surgery with E&M on same day - one of our providers has reached out to the AAD to see if the academy is aware, but we haven't heard anything back yet.


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## trarut (May 24, 2022)

I haven't seen this notification yet but I'm not surprised - we've already had them denying all level 5 visits for at least the last decade because they want medical records before they'll pay.


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## sglamuzina (Jun 26, 2022)

We have not received our letter yet, but I am aware. 
May someone please share their letter me and/or the group. I would love to show my providers as I am confident, they will be asking.


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## OpenClaims (Jun 26, 2022)

What is their reasoning for this? Are they saying it is inclusive? Can someone share this letter so I can see further?


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## dragonclawz70 (Jun 28, 2022)

This is a copy of the letter from Cigna:


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## jkyles@decisionhealth.com (Jun 28, 2022)

This blog post links to a letter that Cigna sent to providers Cigna to require medical records for all modifier 25 claims. It provides more detail about what will be required. 

It's impossible to guess whether private payers will adopt this exact policy, which is pretty extreme. However, Cigna _might _revise or cancel this policy.


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## OpenClaims (Jun 28, 2022)

dragonclawz70 said:


> This is a copy of the letter from Cigna:


Oh, I see. Thank you for the clarification. That is Cigna's specific reimbursement policy. I was confused and unsure if you meant a letter in regards to a specific claim, so I was looking for clarification. With that said, it is impossible to know if other payors will adopt the same policy.


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## Sheri24sm (Jul 5, 2022)

KarenZupko& Associates has an alert for the 25 Mod: 

Modifier 25 Alert!

Are you aware of the latest Aetna, Anthem, and Cigna changes
to Evaluation and Management (E/M) coding?​
*Aetna *is denying modifier 25 claims as a matter of policy.

*Anthem*: Effective July 1, 2022, Anthem is requiring documentation submission for new and established office visits billed with a modifier 25 on the same day as a minor procedure on these encounters:

99212-25 to 99215-25
99202-25 to 99205-25
*Cigna*: Effective August 13, 2022, Cigna is requiring office note submissions when an established patient visit is billed with a modifier 25 on the same day as a minor procedure on these encounters:

99212-25
99213-25
99214-25
99215-25
Per Cigna, "The E&M line will be denied if we do not receive documentation that supports that a significant and separately identifiable service was performed."


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## hayleyjohnsen@yahoo.com (Jul 5, 2022)

Is there any specifics anyone knows about this? What are the cuts anthem/cigna is taking/applying? Is there guidelines on payment? I can't seem to find specifics anywhere.


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## sls314 (Jul 5, 2022)

hayleyjohnsen@yahoo.com said:


> Is there any specifics anyone knows about this? What are the cuts anthem/cigna is taking/applying? Is there guidelines on payment? I can't seem to find specifics anywhere.



My understanding is that the line with the E/M - modifier 25 charge will not be paid separately without documentation showing that it is separately identifiable.  It sounds like the procedure will be paid, just not the E/M charge.


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## cling2me2 (Jul 25, 2022)

FYI - received a letter from Cigna which states this change WILL NOT go into effect on 08/13/22 as planned.  The policy change is being "reevaluated".


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## jrclark1987@yahoo.com (Jul 25, 2022)

cling2me2 said:


> FYI - received a letter from Cigna which states this change WILL NOT go into effect on 08/13/22 as planned.  The policy change is being "reevaluated".


thank you for updating. I have not seen any updates from Anthem or Aetna. If you have those please share.


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## jrclark1987@yahoo.com (Jul 25, 2022)

Sheri24sm said:


> KarenZupko& Associates has an alert for the 25 Mod:
> 
> Modifier 25 Alert!
> 
> ...


thank you so much for sharing


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## jrclark1987@yahoo.com (Jul 25, 2022)

Sheri24sm said:


> KarenZupko& Associates has an alert for the 25 Mod:
> 
> Modifier 25 Alert!
> 
> ...


Have you seen a modifier 57 alert? I fear that will be coming next.


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## mandilou79 (Aug 3, 2022)

How will we send documentation if we send all of those electronically?  This is a mess!!


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## lfontanez (Dec 5, 2022)

jrclark1987@yahoo.com said:


> thank you so much for sharing


Do you know where I can get a copy of this?


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