CIGNA Changes Their Modifier 25 Policy

As a result of a recent review, CIGNA will require the submission of office notes with all claims submitted with 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, but claims should continue to be submitted electronically and must have the attachment indicator selected.

While CIGNA does not define “office notes”, it says the E/M line will be denied if they do not receive documentation that supports that a significant and separately identifiable service was performed.  Denials will include administrative appeal rights.

This update is effective for claims processed on or after August 14, 2022.

There is no discussion about whether the same change will apply to eye codes.  Practices should watch these claims carefully to see if CIGNA is also requiring office notes for eye codes billed with modifier 25.

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.

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