Otolaryngology Coding Alert

Question: I heard Cigna now requires 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. Is this true?

Arizona Subscriber

Answer: Actually, Cigna is 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 … 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. So, for now, we can all breathe a sigh of relief. Although, Cigna will “continue to review for future implementation,” according to a policy update from the company on May 22 (https://static.cigna.com/ assets/chcp/secure/pdf/resourceLibrary/clinReimPolsModifiers/ Notifications/Modifier_25_Significant_Separately_Identifiable_ Evaluation_and_Management.pdf ).

Background: Cigna first notified providers about the policy in May 2022, but the company paused implementation in June to reevaluate the requirement after pushback from medical groups. Cigna reintroduced the policy in March 2023.