Anthem plans to reduce pay for problem-oriented E/M service with Modifier 25
An Anthem Network Update in June announced a reimbursement change for contracted payers in Indiana, Ohio and Wisconsin concerning modifiers 25 and 27. Starting with service dates on or after Oct. 1, 2014, Anthem will reduce by 50 percent the maximum payment allowed for claims when a problem-oriented evaluation and management (E/M) service is eligible for separate reimbursement on the same date of service as a preventive exam.
“This means that beginning in October, Anthem will start reducing your payment for the problem visit if a preventative visit is done at the same time,” said Gloria Kirkham, CPC, CPC-I, COBGC, ISMA practice advisor. “After that time, if you see a patient for an annual visit and that patient wants to discuss a problem that is a significant separately identifiable evaluation and management service – delivered by the same physician on the same day as a procedure or other service and billable with a 25 modifier – you can expect to be paid half as much for the problem visit.”
The ISMA is taking steps to halt this scheduled change, as we did in 2012 when it was last proposed. Please continue reading ISMA Reports for updates on the issue.
Read the official Anthem notice on page 22 here.