June 06, 2022
Area(s) of Interest: Payor Issues and Reimbursement
In late May, Cigna announced that it will begin requiring the submission of medical records with all Evaluation and Management (E/M) claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed.
Modifier 25 allows separate payment for a significant, separately identifiable E/M service provided on the same day as a minor procedure or other reported health care service. The updated Cigna policy – Modifier 25-Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service – will become effective nationwide on August 13, 2022. Failure to submit the required medical records will result in a denial of the E/M service.
The California Medical Association (CMA) has serious concerns with Cigna’s policy change as it will result in significant unnecessary administrative burden and cost to practices to comply, will be a disincentive for physicians to provide unscheduled services and is inconsistent with industry standards. The policy may also be inconsistent with California law.
CMA and the American Medical Association are reaching out to Cigna regarding our concerns.
Practices with questions regarding this policy update can contact Cigna Customer Service at (800) 88Cigna (882-4462).
Practices can also contact CMA at (888) 401-5911 or [email protected].