Update: Anthem BCBS announces modifier 25 payment reduction “stay”

In October, 2017, Anthem BCBS notified providers in their monthly newsletter that they would reduce the separately-identifiable office visit reimbursement by 50% when modifier 25 was appropriately used in conjunction with a minor procedure.[1]  The reimbursement for the minor procedure appears to have been unaffected.

Many state[2] and national medical[3] and ophthalmological[4] societies fought back on this provision.  Anthem BCBS recently posted that this 50% reduction on office visits with modifier 25 would not take place – and that instead, a 25% reduction would be implemented but not take effect until March 1, 2018, for selected states (California, Colorado, Connecticut, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, and Wisconsin. Georgia and Virginia may also be affected upon network contract renewal.)

The societies all make the point that they continue to fight this March 1 provision and that providers should watch for updates.

We are happy to assist providers and groups with payer appeals, chart reviews, compliance, or other documentation and coding concerns.  Please contact us via one of the below or on our “App”, Corcoran 24/7, which can be accessed via your app store.

www.corcoranccg.com (800) 399-6565


[1]  Anthem Blue Cross Blue Shield.  Network Update.  October 2017.  (See page 17 for the initial policy notice).  Link here.  Accessed 01/30/18.

[2]  Ohio Ophthalmological Society.  News article.  01/08/18.  Link here.  Accessed 01/31/18.

[3]  American Medical Association.  AMA Wire. December 27, 2017.  Link here.  Accessed 01/30/18.

[4]  American Society of Cataract and Refractive Surgery.  Legislative and Regulatory.  Washington Watch.  News item. Link here.  Accessed 01/31/18.

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