tci ED Coding & Reimbursement Alert - 2017 Issue 9

Modifiers: This Insurer Is Slashing Pay for Modifier 25 Claims

Be ready to see your income cut in half when you bill modifier 25 to this payer. You probably use modifier 25 on many of your claims, but the odds of collecting full payment for this ubiquitous modifier are suddenly sinking. That's the word from Pennsylvania's Independence Blue Cross Blue Shield, which is making drastic reimbursement changes to the modifier. Here's the scoop: Effective Aug. 1, Independence will reimburse claims appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or...

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