Oncology & Hematology Coding Alert

Question: Is Cigna now requiring the submission of documentation via email or fax to support the use of modifier 25 when billed with E/M CPT® codes 99212-99215 and a minor procedure?

Delaware Subscriber

Answer: Cigna is once again delaying the implementation of a policy that would have required the submission of medical records when using 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) for all evaluation and management (E/M) claims billed with 99212-99215 and a minor procedure. The policy had been set to go into effect on May 25, 2023, but the payer sent out communication on May 22 putting a hold on the policy change. So, for now, breathe a sigh of relief, although Cigna will “continue to review for future implementation,” according to the update (https:// static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/ clinReimPolsModifiers/Notifications/Modifier_25_Significant_ Separately_Identifiable_Evaluation_and_Management.pdf).