Last year, insurance giant Anthem made headlines by announcing that they would halve the reimbursement for any evaluation and management (E/M) procedure billed with modifier 25. This modifier, used to indicate a “significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service,” is far from rare, so coders, billers, and providers everywhere were understandably upset. This modifier 25 payment reduction caused such a ripple within the medical community that the American Medical Association (AMA) reached out to Anthem specifically to request that this change be cancelled.
In response, Anthem responded that it would change the modifier 25 payment reduction from 50% to 25%. Although still a hefty cut, Anthem argued that this would be far less costly than the original plan to cut reimbursement completely in half. The insurance provider also changed the implementation date for this policy to March 1st, 2018, giving practices everywhere more time to prepare. In their eyes, it seemed like a fair compromise.
But this change was still not enough. The AMA, along with countless other medical societies such as the American College of Rheumatology (ACR), continued to protest the modifier 25 payment reduction in hopes that Anthem would finally relent. In the end, their voices were heard. At the very end of February, less than a week before the reduced reimbursement plan was to go into effect, Anthem formally announced that they would be cancelling all plans to change the payment status for modifier 25. According to their official letter, “[Anthem] 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.”