Shauswald
New
Received a letter from Cigna today stating effective 8/13/22 they will be requiring a chart note with every claim that a 25 modifier is used. Wondering if other insurances will follow suit?
Our office has received the same letter stating that they will require documentation to support a minor surgery with E&M on same day - one of our providers has reached out to the AAD to see if the academy is aware, but we haven't heard anything back yet.Received a letter from Cigna today stating effective 8/13/22 they will be requiring a chart note with every claim that a 25 modifier is used. Wondering if other insurances will follow suit?
Oh, I see. Thank you for the clarification. That is Cigna's specific reimbursement policy. I was confused and unsure if you meant a letter in regards to a specific claim, so I was looking for clarification. With that said, it is impossible to know if other payors will adopt the same policy.This is a copy of the letter from Cigna:
Is there any specifics anyone knows about this? What are the cuts anthem/cigna is taking/applying? Is there guidelines on payment? I can't seem to find specifics anywhere.
thank you for updating. I have not seen any updates from Anthem or Aetna. If you have those please share.FYI - received a letter from Cigna which states this change WILL NOT go into effect on 08/13/22 as planned. The policy change is being "reevaluated".
thank you so much for sharingKarenZupko& Associates has an alert for the 25 Mod:
Modifier 25 Alert!
Are you aware of the latest Aetna, Anthem, and Cigna changes
to Evaluation and Management (E/M) coding?
Aetna is denying modifier 25 claims as a matter of policy.
Anthem: Effective July 1, 2022, Anthem is requiring documentation submission for new and established office visits billed with a modifier 25 on the same day as a minor procedure on these encounters:
Cigna: Effective August 13, 2022, Cigna is requiring office note submissions when an established patient visit is billed with a modifier 25 on the same day as a minor procedure on these encounters:
- 99212-25 to 99215-25
- 99202-25 to 99205-25
Per Cigna, "The E&M line will be denied if we do not receive documentation that supports that a significant and separately identifiable service was performed."
- 99212-25
- 99213-25
- 99214-25
- 99215-25
Have you seen a modifier 57 alert? I fear that will be coming next.KarenZupko& Associates has an alert for the 25 Mod:
Modifier 25 Alert!
Are you aware of the latest Aetna, Anthem, and Cigna changes
to Evaluation and Management (E/M) coding?
Aetna is denying modifier 25 claims as a matter of policy.
Anthem: Effective July 1, 2022, Anthem is requiring documentation submission for new and established office visits billed with a modifier 25 on the same day as a minor procedure on these encounters:
Cigna: Effective August 13, 2022, Cigna is requiring office note submissions when an established patient visit is billed with a modifier 25 on the same day as a minor procedure on these encounters:
- 99212-25 to 99215-25
- 99202-25 to 99205-25
Per Cigna, "The E&M line will be denied if we do not receive documentation that supports that a significant and separately identifiable service was performed."
- 99212-25
- 99213-25
- 99214-25
- 99215-25
Do you know where I can get a copy of this?thank you so much for sharing