decisionhealth Newsletters, Coder Pink Sheets - 2026 Issue 6 (June)
LCDs & Policies: Michigan BCBS to cut E/M pay in half when billed with modifier 25 and minor surgery
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Article Overview
The article covers the planned policy, the health plans it applies to, responses from medical societies, and the payer’s descriptions of service categories excluded from the payment change. It also places the policy in the context of recent reimbursement policies from other commercial payers.
Why This Topic Matters
The policy may affect reimbursement for practices that provide office-based procedures alongside evaluation and management services, particularly in procedural and surgical specialties.
Article Sections
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Diagnostic tests, post-ER visits, decision for surgery excluded
This section reviews categories of services and circumstances discussed as exclusions from the policy, including diagnostic services and visits following emergency care.
What You Will Learn
- The scope and timing of the reported Michigan BCBS policy
- Which health plans the article identifies as affected
- How medical societies and the payer have responded to the policy
- The broad service categories discussed as exclusions
- How the policy fits within recent commercial-payer reimbursement developments
Who Should Read This
- Physicians and other clinicians
- Medical practice administrators
- Medical billing and coding professionals
- Revenue cycle and compliance professionals
- Healthcare policy professionals
Code Ranges Discussed
Modifiers Discussed
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