Anthem Will Not Give Modifier 25 a Pay Cut

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Mar 1st, 2018

Anthem's original plan was to take a 50% reduction when providers reported claims using modifier 25, it was then lowered to a 25% reduction and has now been fully rescinded, to the relief of providers.  The policy was to go into effect March 1, 2018, however, due to strong opposition from the American Medical Association and other groups Anthem decided it was not in the best interest between payers and providers. 

The reductions were to include the following states; California, Colorado, Connecticut, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, and Wisconsin.  Notification will be sent out to providers this week.