CAFP sent a letter to Cigna conveying concerns regarding the reimbursement policy change for evaluation and management (E/M) services billed with modifier -25 and minor procedure codes. The revised policy will require submission of medical records via fax or email for all claims billed with CPT codes 99212-99215 with modifier -25 and a minor procedure code and was scheduled to go into effect May 25, 2023. Failure to submit records would have resulted in a denial of the E/M service. CAFP urged Cigna to reconsider this policy due to the negative impact it will have on family physicians. To view the letter, visit here.
In consideration of CAFP’s feedback, Cigna has decided to delay implementation of the Modifier 25 policy in California until June 11th. At that time, while the policy will generally be effective for California providers, they will continue to allow reimbursement when modifier 25 is appropriately billed with an E&M code for patients with certain insurance, even where providers have not submitted office notes supporting the significant and separately identifiable service. See Cigna’s response to CAFP here. CAFP will continue to engage with Cigna to reduce administrative burdens for physicians.