CIGNA DELAYSCONTROVERSIAL MODIFIER25 POLICY AGAIN

This is the second time Cigna has delayed this unpopular proposed policy The policy was first introduced in 2022, but Cigna delayed implementation, presumably due to physician opposition

In March of 2023, Cigna announced it would implement the policy in certain states on May 25, 2023, but again announced its delay on May 22, 2023 The policy requires professional fee providers to submit office notes (via email or fax) when billing office visit codes 99212-99215 with modifier 25. Modifier 25 indicates the E/M was a separate and distinct service performed during the same visit as another billable procedure

Under Cigna?s new policy, if office notes were not submitted by email or fax to support the claim, payment would be denied

A link and an excerpt from the policy is provided below: https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/clinReimPolsModifi ers/Notifications/Modifier 25 Significant Separately Identifiable Evaluation and M anagement pdf ?

? Cigna requires the submission of office notes with claims submitted with E/M CPT® codes 99212, 99213, 99214 and 99215, and modifier 25 when billed with a minor procedure. The E/M line will be denied if Cigna does not receive adequate documentation to support that a significant and separately identifiable service was performed The documentation should be submitted with a cover sheet indicating the office notes supports the use of modifier 25 appended to the E/M code.?

A number of physician organizations, including the American Medical Association (AMA), the American Academy of Family Physicians (AAFP), and several other major medical groups have unleashed public letter-writing campaigns to persuade Cigna not to implement the new policy.