Anthem Blue Cross and Blue Shield Withdrawal of Modifier 25 Policy

March 2018 ~

Anthem Blue Cross and Blue Shield (BCBS) has published a notice informing health care professionals and policyholders that the insurer will not be moving forward with implementation of the reimbursement policy relating to physician use of payment modifier 25.

The policy had previously been scheduled to take effect on March 1, 2018, but following discussions with the American Medical Association (AMA), national medical specialty societies, state medical associations and individual health care professionals, Anthem BCBS says it has “made the decision to not proceed with the reimbursement policy impacting physician use of payment Modifier 25.”

In a letter to the AMA, the insurer states “while Anthem is confident that duplication of payment for fixed/indirect practice expenses exists when physicians bill an E/M service appended with modifier 25 along with a minor surgical procedure (0 or 10 day global) performed on the same day, the company believes making a meaningful impact on rising health care costs requires a different dialogue and engagement between payers and providers.  As such, Anthem looks forward to pursuing an effective collaboration with the AMA to truly transform health care in our country to make it simpler, higher?quality, affordable and accessible.”

View the notice from Anthem BCBS, here.



Source(s): Anthem Blue Cross and Blue Shield; Anthem Letter; American Medical Association;