decisionhealth Newsletters, Part B News - 2017 Issue 8 (August)
Update: E/M pay cut tied to modifier 25 affects only certain payer plans
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Article Overview
This article explains a payer-specific payment policy affecting evaluation and management claims that include modifier 25, with context on the insurers involved, the effective date, and how the policy compares with broader Medicare billing practices. It is aimed at coders, billers, and practice staff who need to understand whether the change applies to their patient population and reimbursement workflows.
Why This Topic Matters
The policy may reduce payment for certain claims under specific payer plans, so practices need to know whether their patients are affected and how the change differs from usual reimbursement patterns.
Article Sections
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Billing
Overview of the payer policy change, the plans and organizations affected, and the timing of the update. Includes general discussion of how the policy differs from other payer approaches.
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Resource
Reference to a service map and related organizational coverage information.
What You Will Learn
- Which payer plans are affected by the policy update
- How the change relates to evaluation and management claims with modifier 25
- When the policy took effect
- How the policy compares with broader Medicare-related payment practices
- Where to find the referenced service coverage map
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice administrators
- Physician office staff
Codes Discussed
Modifiers Discussed
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