Cigna Delays Modifier 25 Policy Change for Evaluation & Management Services

Cigna will not move forward with changes to its reimbursement policy for evaluation and management (E/M) codes submitted with modifier 25 as originally scheduled.

The company had previously announced that, effective Aug. 13, all claims billed with modifier 25 would be automatically denied unless accompanied by a full set of office notes. The ACR sent a letter to Cigna expressing concern that the change would result in inappropriate denials or delayed payments for legitimate E/M services and increase the already high administrative burden on rheumatology practices.

In a recent update to providers, Cigna reported that it is reevaluating the policy change and that implementation has been delayed indefinitely. Additional details will be communicated after its internal evaluation is complete.

The ACR will continue to monitor this issue and follow up with Cigna as needed. We encourage ACR/ARP members to contact [email protected] with any questions or concerns.