The Rheumatologist
COVID-19 NewsACR Convergence
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Axial Spondyloarthritis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Interprofessional Perspective
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Gout Resource Center
      • Axial Spondyloarthritis Resource Center
      • Psoriatic Arthritis
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Anthem Cancels Planned Modifier 25 Cuts

Anthem Cancels Planned Modifier 25 Cuts

February 28, 2018 • By From the College

  • Tweet
  • Email
Print-Friendly Version / Save PDF

Anthem, a Blue Cross Blue Shield company that operates in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio, Virginia and Wisconsin, has decided not to move forward with a policy that would have resulted in decreased reimbursement for evaluation and management (E/M) services when billed with modifier 25.

You Might Also Like
  • Anthem Updates Modifier 25 Policy Changes after Talks with AMA
  • Anthem to Reduce E/M Reimbursement When Billed with Modifier 25
  • ACR Advocates Against Proposed UHC Policy Changes
Also By This Author
  • Rheumatology Coding Corner Question: Billing for an Inflectra Infusion

As reported in the Dec. 28, 2017, and Jan. 11, 2018, editions of [email protected], Anthem announced last fall that it planned to cut reimbursement for E/M services by 50% when billed with modifier 25. After an outcry of opposition from the ACR, American Medical Association (AMA), and other state and national medical societies, Anthem announced in late December that it would reduce the cut to 25% and push back the implementation date to March 1 for plans in California, Colorado, Connecticut, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, New York, Ohio and Wisconsin. The policy was also scheduled to take effect in Georgia and Virginia upon contract renewal.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

The ACR, along with the AMA and other medical societies, continued to vocalize its opposition to this policy and the unjustified reduction of physician payments. We are pleased to share that as a result of these advocacy efforts Anthem has decided not to move forward as planned. There will be no cut to reimbursement for E/M services. The ACR applauds this decision and Anthem’s expressed commitment to engaging in a dialogue with providers in an effort to address our shared concern of rising healthcare costs.

The ACR is dedicated to advocating for insurance issues and policies on behalf of our members. Visit the ACR website for more information and to learn how you can get involved. If the ACR can assist you with a payer issue or if you would like to report an insurance issue you are experiencing, contact ACR staff at [email protected]

ad goes here:advert-2
ADVERTISEMENT
SCROLL TO CONTINUE

Filed Under: Billing/Coding, From the College, Practice Management Tagged With: Anthem Inc., evaluation and management (E/M) services, modifier 25, reimbursement cuts

You Might Also Like:
  • Anthem Updates Modifier 25 Policy Changes after Talks with AMA
  • Anthem to Reduce E/M Reimbursement When Billed with Modifier 25
  • ACR Advocates Against Proposed UHC Policy Changes
  • U.S. Doctors Group Says Planned Health Mergers Are Anti-Competitive

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

Meeting Abstracts

Browse and search abstracts from the ACR Convergence and ACR/ARP Annual Meetings going back to 2012.

Visit the Abstracts site »

Simple Tasks

Learn more about the ACR’s public awareness campaign and how you can get involved. Help increase visibility of rheumatic diseases and decrease the number of people left untreated.

Visit the Simple Tasks site »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use / Cookie Preferences

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2023 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)