decisionhealth Newsletters, Part B News - 2018 Issue 9 (September)
Proposed 50% markdown on E/M+25 scenarios means losses for common combos
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Article Overview
This premium article reviews a proposed 2019 Medicare physician fee schedule change and its potential impact on claims that include modifier 25. It is aimed at coders, billers, compliance staff, and clinicians who submit or review evaluation and management claims alongside procedures. The article focuses on the general policy change, the kinds of services commonly affected, and examples of how payment may shift across frequently billed combinations.
Why This Topic Matters
Anyone who bills E/M services with procedures or other services may be affected by the proposed payment reduction. Understanding the scope of the change helps practices anticipate revenue impact and review claim workflows.
What You Will Learn
- What proposed Medicare policy change is being discussed
- Which broad types of claims may be affected by modifier 25 scenarios
- How common service combinations may be impacted at a high level
- Why the issue matters for physician practices and specialty billing workflows
Who Should Read This
- Medical coders
- Medical billers
- Compliance professionals
- Physician practice administrators
- Clinicians who submit claims
- Revenue cycle teams
Codes Discussed
Modifiers Discussed
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