BY CAROL HOPPE, CPC, CCS-P, CPC-I
The ISMA recently learned that Cigna will require the submission of documentation to support the use of modifier 25 when billed with Established Patient E/M CPT® codes 99212 – 99215 and a minor procedure. Cigna has released its revised modifier 25 policy and has notified providers of this change. Effective May 25, all claims with modifier 25 appended to CPT codes 99212, 99213, 99214 and 99215 will need documentation submitted supporting a “significant and separately identifiable service” was performed in addition to the minor procedure, or the E/M code will not be paid. 

The documentation should be submitted with a cover sheet indicating that the office notes support the use of modifier 25 appended to the E/M code. The attachment indicator must be selected, and the office notes must be faxed to 833-462-1360 or emailed to modifier25medicalrecords@cigna.com. 

The following information must be included on a cover sheet:

• Provider or billing name
• Tax ID
• Alternative member ID
• Patient name
• Date of service

This places a significant and unnecessary burden on physician practices and will cause a delay in reimbursement.

The ISMA has signed on to a letter from the AMA urging Cigna to reconsider this policy due to its negative impact on practice administrative costs and burdens across medical specialties and geographic regions, as well as its potential negative effect on patients, and instead partner with organizations on a collaborative educational initiative to ensure the correct use of modifier 25.