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Anthem Agrees to Fully Rescind Proposed Modifier 25 Cuts

Published Feb. 23, 2018

This afternoon, Anthem notified the American Medical Association (AMA) that it plans to fully rescind its policy to reduce payments for E&M services reported with CPT modifier 25.

The announcement follows months of pushback on the policy from organized medicine, led by the AMA, which met with Anthem about the changes.  Kentucky Medical Association (KMA) and Greater Louisville Medical Society (GLMS) leadership also met with local Anthem officials in December to strongly oppose the policy and advocate for its retraction. Both organizations also participated in public relations outreach on the issue.  KMA’s Jan. 5 op-ed in the Lexington Herald Leader was critical of several recent Anthem policies, including the modifier 25 change, and received widespread coverage. It was followed by an op-ed published in the Louisville Courier-Journal by GLMS President Rob Zaring, MD, just last week.

According to the letter from Anthem’s Chief Clinical Officer Craig E. Samitt, M.D., which is available in its entirety here, Anthem has expressed commitment to “continuing to work with the AMA, state medical associations, and national medical specialty societies to address physician concerns with other policies and guidelines.”

The letter also states that while Anthem is confident that duplication of payment exists when physicians bill an E/M service on the same day as a minor surgical procedure, “the company believes making a meaningful impact on rising health care costs requires a different dialogue and engagement between payers and providers.”

The proposed changes were scheduled to be implemented in Kentucky on March 1.  Anthem will formally notify its contracted providers within the next few days of this decision.

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