Cigna backs off on tough new modifier 25 policy – for now

by: Laura Evans, CPC May 25, 2023

Just days before it was to take effect, Cigna announced it would “delay implementation” of a strict new policy for E/M services billed with modifier 25 (Significant, separately identifiable E/M service by the same physician on the same date as a procedure).

The new policy would have required practices to submit documentation to support the use of modifier 25 with E/M codes 99212-99215 when reported on the same date as a minor procedure.

The payer first unveiled the policy last summer, then postponed its activation after protests from the AMA and some state medical societies that it would be too burdensome for practices and would impact patient care.

The payer then announced in March this year that it would go live with the policy on May 25. But on May 23, Cigna announced it would postpone it, and did not supply a new implementation date. “Cigna will continue to review for future implementation,” the insurance company stated.

Physician societies had protested the policy when it was first announced, stating that it would have caused unnecessary paperwork and potential denials for practices, and would have disincentivized physicians from providing unscheduled care.

In a letter to Cigna decrying the policy, the California Medical Association said it would have penalized physicians “for providing efficient, unscheduled care to Cigna enrollees.”

Editor's note: Need help with modifier 25 reporting? Access a new decision tree to help expedite your decision-making (subscribers only).

Blog Tags: claims processing, private payers

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