Advanced Search

Practice Management Alert

Payer Updates:

Horizon BCBS Revises Modifier 25 Cut

Published on Sun Mar 21, 2010

Same-day E/M services will be paid full rate. Providers who contract with Horizon Blue Cross Blue Shield (BCBS) of New Jersey can expect a small reprieve on modifier payment cuts, according to a recent memo issued by Horizon. In the memo, Richard Popiel, MD, MBA, vice president and chief medical officer of health affairs for Horizon BCBS, says "we are revising our modifier 25 approach so that when two E&M services are billed for the same patient, on the same date of service, we will consider the E&M service appended appropriately with modifier 25 at 50 percent of the applicable Horizon BCBSNJ fee schedule and consider the other E&M service at 100 percent of the applicable Horizon BCBSNJ fee schedule." In a February 2010 memo, Horizon BCBS stated that they would be cutting reimbursement by half on many modifiers, regardless of the circumstances surrounding their use. The move is merely [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Practice Management Alert

View All