Cigna has delayed implementation of changes to its modifier 25 reimbursement policy after receiving significant pushback from the American Medical Association (AMA), ACR and other medical societies.
The policy changes, originally scheduled to take effect May 25, 2023, would have required providers to submit medical records with all modifier 25 claims. Cigna would have denied evaluation and management (E/M) claims that did not include documentation showing that a significant and separately identifiable service was performed.
The ACR expressed concern to Cigna that the policy would result in inappropriate denials or delayed payments for legitimate E/M services and increase the already high level of administrative burden on rheumatology practices. The College also joined over 100 other physician and healthcare organizations that signed an AMA-led letter to the payer.
Details about future implementation plans are forthcoming; however, Cigna has committed to working more collaboratively with stakeholders.
