Anthem Cancels Planned Modifier 25 Cuts

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.

As reported in the Dec. 28, 2017, and Jan. 11, 2018, editions of ACR@Work, 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.

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 practice@rheumatology.org.