New Policy of Cigna regarding Modifier 25

Cigna will require the submission of documentation to support the use of modifier 25 when billed with Established Patient E/M CPT codes 99212 – 99215 along with a minor procedure. Cigna has released its revised modifier 25 policy and has notified providers of this change.

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?Effective May 25, all claims with modifier 25 appended to CPT codes 99212, 99213, 99214 and 99215 will need documentation submitted supporting a “significant and separately identifiable service” was performed in addition to the minor procedure, or the E/M code will not be paid.?

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The E &M line will be denied if the document is not submitted. Denials will include administrative appeals rights.

The documentation should be submitted with a cover sheet indicating that the office notes support the use of modifier 25 appended to the E/M code. The attachment indicator must be selected, and the office notes must be faxed to 833-462-1360 or emailed to?[email protected].?

The following information must be included on a cover sheet:

• Provider or billing name
• Tax ID
• Alternative member ID
• Patient name
• Date of service

The AMA and health care professionals across the country have sent a letter to Cigna to revoke its policy due to its negative impact on practice administrative costs and burdens across medical specialties and geographic regions and its potential negative effect on patients. A request was sent to Cigna to remove this inaccurate statement from the policy, as it contradicts both CMS and CPT guidelines indicating that an E/M service reported with modifier 25 does not need a different diagnosis than what was reported for the concurrent procedure. Failing to rescind the policy would result in an enormous amount of office notes being sent with claims, burdening network providers and the insurer.