Medical Community Advocacy Prompts Anthem to Fully Rescind Payment Cuts for E&M Codes Billed with Modifier 25
Following reports that Anthem notified physicians in many states that it will begin reducing payments by 50% for evaluation and management (E&M) codes reported with a Current Procedural Terminology (CPT) modifier 25, the medical community intervened to prevent the cuts. In response, Anthem has announced that it will not move forward with its planned payment cuts. Last month, Anthem had originally responded to the medical community’s advocacy by lowering the proposed reduction to 25%. Anthem will be sending formal notification of the restoration of the full payment to providers within the coming days.
As a reminder, Anthem originally proposed a policy change that would have reduced payments by 50% for evaluation and management (E&M) codes reported with a Current Procedural Terminology (CPT) modifier 25. The medical community strongly opposed these cuts and intervened by sending a letter to Anthem requesting that the insurance company suspend its new payment policy. Following the letter, the AMA met with Anthem leadership and provided information on how the recommendations of the AMA/Specialty Society Relative Value Scale Update Committee (RUC) do not include duplicative physician work or practice expense for procedures typically billed with an E&M service on the same date, therefore indicating that implementation of Anthem’s proposed policy would negatively impact physician payments and practice expenses. Anthem agreed to review the information the AMA provided during the meeting and indicated it would amend the policy if needed. Following the meeting, Anthem announced that payments will be reduced by 25% instead of 50%, as originally planned. The AMA and medical community continued to voice strong objections against the policy proposal which ended in Anthem fully rescinding modifier 25 cuts.