Part B Insider (Multispecialty) Coding Alert

Reader Question:

Anthem Decides to Keep Modifier 25 Policy Status Quo

Published on Mon May 21, 2018

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Question: Last year, we heard Anthem would start cutting its modifier 25 payment by 50 percent. When will that go into effect?

Codify Subscriber

Answer: Fortunately, you don't have to worry about those cuts now, 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 healthcare professional on the same day of the procedure or other service) by 50 percent. 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 American Medical Association (AMA) in February that it would not be instituting any pay cuts for claims involving modifier 25.

Medicare Part B providers were relieved to have escaped the pay cuts, which are already in effect for Independence Blue Cross Blue Shield (See Part B Insider, Vol. 18, No. 9).