tci Medicare Compliance & Reimbursement - 2018 Issue 8

Reader Question: Anthem Opts Not to Change Modifier 25 Policy

Question: Last year, we heard Anthem would start cutting its modifier 25 payment by 50 percent. When will that go into effect? Subscriber Answer: Fortunately, you don't have to worry about those cuts now, because Anthem has decided not to institute them. Background: Last year, Anthem announced plans to cut pay for E/M codes appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) by 50 percent. As 2017 came to a close, Anthem decided it...

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