Gastroenterology Coding Alert

Question: When will Anthem start cutting its modifier 25 payment by 50 percent? We've heard a few different dates, but we don't know which one is accurate.

Codify Subscriber

Answer: Fortunately, you don't have to worry about those cuts, because Anthem has decided not to institute them.

Background: Last year, Anthem announced plans to cut pay for E/M codes appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service)  by 50 percent. The AMA and GI specialty societies protested the reductions as inappropriate and arbitrary. As 2017 came to a close, Anthem decided it would go easier on practices by only cutting modifier 25 pay by 25 percent.

Fortunately, however, Anthem has scrapped the entire plan to reduce modifier 25 pay. Anthem's Chief Clinical Officer, Craig E. Samitt, MD, MBA, alerted the AMA in February that it would not be instituting any pay cuts for claims involving modifier 25.

Gastroenterology practices were relieved to have escaped the pay cuts, which are already in effect for Independence Blue Cross Blue Shield.