Cigna Change Modifier 25 Policy

As a result of a recent review, Cigna has announced it will require the submission of office notes with claims submitted for evaluation and management (E/M) CPT codes 99212, 99213, 99214, and 99215, and modifier 25 when a minor procedure is billed.  The required office notes must be submitted via the dedicated fax number (833) 462-1360 or, but claims should continue to be submitted electronically and must have the attachment indicator selected.  Cigna indicated that claims and documentation will also be accepted by mail.

Cigna’s instructions say to Include a cover letter with the following information when sending information via email or fax:

  • Provider of biller name
  • Provider Tax ID Number (TIN)
  • Alternate Member Identification (AMI)
  • Patient name
  • Date of service

The E/M line will be denied if they do not receive documentation supporting that a significant and separately identifiable service was performed.  Denials will include administrative appeal rights.

Practices are receiving letters with varying effective dates for this change, although most are in May and June, 2023.

We are happy to assist you with claims issues and other topics related to eye care.  Check back often for updated News Items related to billing, documentation, and operations related to your practices.  Stay safe.  (800) 399-6565


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