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Wiki Anthem Modifier 25 Policy

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daedolos

daedolos

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Local Chapter Officer
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Just was informed through the Navicure webinar on Key Performance Indicators that Anthem is instituting a 25 modifier reduction on claims for all E/M services for global periods under 10 days. It will affect the visits regarding care for pain management (injections) and fracture aftercare. Was CMS already implementing this policy?

Peace
@_*
Ugh
 
Its not being done under CMS direction. Its being done under a corporate medical policy. Expect other payers to follow if they haven't already. Its been talk for a while now at some other payers but no one wanted to be the first to pull the trigger.
 
DO you know of any policy or guideline stating that new patients do not need a 25 modifier on the E/M for office visits if a procedure was done?

Peace
?_?
 
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