Wiki Revision to Modifier 25 Policy for CIGNA


True Blue
Overland Park, KS
Best answers
CIGNA has announced a major update to their policy regarding the use of modifier 25. Effective 05/25/2023 Cigna will require the submission of documentation to support the use of modifier 25 when billed with E/M CPT® codes 99212 – 99215 and a minor procedure.

I have attached the revised policy for your review.


  • Modifier_25_Significant_Separately_Identifiable_Evaluation_and_Management.pdf
    253.4 KB · Views: 79
Thanks for sharing this. CIGNA first announced the policy in 2022 but withdrew it before implementation in response to objections by medical societies. Maybe they'll back down again.

Some details here:
I'm not in CA, but I LOVE that letter CMA created. I am already pulling out some key phrases to put in my coverletter every time I have to submit records for a completely justified -25 modifier.
More like delay...again.

Here are the details regarding its announced delay:

  • Cigna is currently reevaluating this reimbursement policy update, which will delay implementation.
  • Cigna will look to implement this policy later, when it can optimize the provider experience and perform additional provider education in partnership with key national medical associations.
  • Cigna will communicate a new implementation date and additional details later.
  • Cigna appreciates your partnership and patience and looks forward to working more collaboratively with provider partners, medical associations, and their membership to ensure that modifier 25 is used appropriately and in alignment with national guidelines and industry standards.
Pain Med was one of several societies who signed onto a letter sent to Cigna. This was an update provided at the end of the week.