tci Part B Insider - 2017 Issue 9

Modifiers: Anticipate Pay Cuts for Modifier 25 Claims, Private Payer Says

One insurer is slashing modifier 25 claims in half — others may follow. Many practices append modifier 25 to their E/M claims, but the chances of receiving full payment for this ubiquitous modifier are waning. That’s the word from Pennsylvania’s Independence Blue Cross Blue Shield, which is making drastic reimbursement changes to the modifier. Inside story: Effective Aug. 1, 2017, Independence will reimburse claims appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified healthcare professional on the same day of the procedure or other service) “at 50...

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