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Wiki Cigna 25 modifier policy

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Shauswald

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Received a letter from Cigna today stating effective 8/13/22 they will be requiring a chart note with every claim that a 25 modifier is used. Wondering if other insurances will follow suit?
 
What do they mean exactly by a 'chart note'? If they're referring to reported an encounter with a separate E/M with appended modifier 25. Example: 99215-25, 99396. Some payors are not wanting to pay for the supported separate E/M, so this may be their way of trying to get around that. I know that BCN is not wanting to pay for these.
 
Shauswald said:
Received a letter from Cigna today stating effective 8/13/22 they will be requiring a chart note with every claim that a 25 modifier is used. Wondering if other insurances will follow suit?
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Our office has received the same letter stating that they will require documentation to support a minor surgery with E&M on same day - one of our providers has reached out to the AAD to see if the academy is aware, but we haven't heard anything back yet.
 
I haven't seen this notification yet but I'm not surprised - we've already had them denying all level 5 visits for at least the last decade because they want medical records before they'll pay.
 
We have not received our letter yet, but I am aware.
May someone please share their letter me and/or the group. I would love to show my providers as I am confident, they will be asking.
 
What is their reasoning for this? Are they saying it is inclusive? Can someone share this letter so I can see further?
 
dragonclawz70 said:
This is a copy of the letter from Cigna:
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Oh, I see. Thank you for the clarification. That is Cigna's specific reimbursement policy. I was confused and unsure if you meant a letter in regards to a specific claim, so I was looking for clarification. With that said, it is impossible to know if other payors will adopt the same policy.
 
KarenZupko& Associates has an alert for the 25 Mod:

Modifier 25 Alert!

Are you aware of the latest Aetna, Anthem, and Cigna changes
to Evaluation and Management (E/M) coding?​

Aetna is denying modifier 25 claims as a matter of policy.

Anthem: Effective July 1, 2022, Anthem is requiring documentation submission for new and established office visits billed with a modifier 25 on the same day as a minor procedure on these encounters:
  • 99212-25 to 99215-25
  • 99202-25 to 99205-25
Cigna: Effective August 13, 2022, Cigna is requiring office note submissions when an established patient visit is billed with a modifier 25 on the same day as a minor procedure on these encounters:
  • 99212-25
  • 99213-25
  • 99214-25
  • 99215-25
Per Cigna, "The E&M line will be denied if we do not receive documentation that supports that a significant and separately identifiable service was performed."
 
hayleyjohnsen@yahoo.com said:
Is there any specifics anyone knows about this? What are the cuts anthem/cigna is taking/applying? Is there guidelines on payment? I can't seem to find specifics anywhere.
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My understanding is that the line with the E/M - modifier 25 charge will not be paid separately without documentation showing that it is separately identifiable. It sounds like the procedure will be paid, just not the E/M charge.
 
Sheri24sm said:
KarenZupko& Associates has an alert for the 25 Mod:

Modifier 25 Alert!

Are you aware of the latest Aetna, Anthem, and Cigna changes
to Evaluation and Management (E/M) coding?​

Aetna is denying modifier 25 claims as a matter of policy.

Anthem: Effective July 1, 2022, Anthem is requiring documentation submission for new and established office visits billed with a modifier 25 on the same day as a minor procedure on these encounters:
  • 99212-25 to 99215-25
  • 99202-25 to 99205-25
Cigna: Effective August 13, 2022, Cigna is requiring office note submissions when an established patient visit is billed with a modifier 25 on the same day as a minor procedure on these encounters:
  • 99212-25
  • 99213-25
  • 99214-25
  • 99215-25
Per Cigna, "The E&M line will be denied if we do not receive documentation that supports that a significant and separately identifiable service was performed."
Click to expand...
thank you so much for sharing
 
Sheri24sm said:
KarenZupko& Associates has an alert for the 25 Mod:

Modifier 25 Alert!

Are you aware of the latest Aetna, Anthem, and Cigna changes
to Evaluation and Management (E/M) coding?​

Aetna is denying modifier 25 claims as a matter of policy.

Anthem: Effective July 1, 2022, Anthem is requiring documentation submission for new and established office visits billed with a modifier 25 on the same day as a minor procedure on these encounters:
  • 99212-25 to 99215-25
  • 99202-25 to 99205-25
Cigna: Effective August 13, 2022, Cigna is requiring office note submissions when an established patient visit is billed with a modifier 25 on the same day as a minor procedure on these encounters:
  • 99212-25
  • 99213-25
  • 99214-25
  • 99215-25
Per Cigna, "The E&M line will be denied if we do not receive documentation that supports that a significant and separately identifiable service was performed."
Click to expand...
Have you seen a modifier 57 alert? I fear that will be coming next.
 
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