Cigna Hits the Brakes on Their New Modifier 25 Policy

Following fierce opposition from the physician community, the insurer Cigna announced today a delay in implementing a policy (PDF) that would have required submitting medical records to support the use of modifier -25 on evaluation and management (E/M) services when billed with a minor procedure. The delay applies to all states.

Physicians in most states would have had to comply with the policy beginning Thursday, May 25, but Cigna said it would pause implementation and continue to review it. The payer had previously delayed implementation in only a handful of states (California, Colorado, Kentucky, Ohio, and Texas). Cigna has now delayed the policy until an unspecified date for all states.

Modifier -25 signifies that on the day a procedure was performed, the patient’s condition required a significant, separately identifiable E/M service (CPT codes 99212-99215).

Under Cigna’s policy, providers would have had to schedule separate evaluation and management visits to avoid the added paperwork and risk of denials. Additional visits would have threatened patients’ adherence to treatment plans and increased their co-payments.

“We are evaluating feedback from our provider partners about this update, and we expect to implement this policy update at a future time. Providers will be notified in advance of the new implementation date after we complete our evaluation,” Cigna Medical Director Ari Gutman, MD, MBA, FAAD, said.

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