AMA Issues Statement Regarding Cigna Modifier 25 Policy

A recent policy announced by commercial healthcare payer The Cigna Group, which mandates the submission of office notes along with claims for specific evaluation and management (E/M) CPT® codes and modifier 25, is causing significant concerns among physicians and healthcare professional organizations. The American Medical Association (AMA) recently released a statement about their concerns surrounding this policy.

https://www.ama-assn.org/practice-management/cpt/cigna-s-modifier-25-policyburdens-doctors-and-deters-prompt-care https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/clinReimPolsModifiers/ Notifications/Modifier 25 Significant Separately Identifiable Evaluation and Management pdf

In March, the Cigna Group announced that effective May 25, 2023, they would reinstate their policy requiring submission of office notes with all claims including E/M codes 99212, 99213, 99214 and 99215 and modifier 25 when a minor procedure is billed on the same claim. Payment will be denied if medical records are not submitted to support the claim.

Last month, physician organizations co-signed a letter to Cigna CEO David Cordani, stating that this policy poses a significant and unnecessary burden on physician practices and negatively impacts patient care.