OSMA/National Response to Cigna's Re-release of Modifier 25 Policy
Cigna is re-releasing its policy to require the submission of medical records with all Evaluation and Management (E/M) claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed.
The updated Cigna policy – Modifier 25-Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service – is scheduled to become effective nationwide on May 25, 2023.
In May 2022, Cigna first notified providers that it would begin requiring the submission of medical records with all Evaluation and Management (E/M) claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed. But then announced in July 2022 it was pausing implementation to reevaluate the policy. Unfortunately, Cigna recently announced it will be moving forward with, essentially, the same policy effective May 25, 2023.
On April 18, OSMA joined the AMA and almost 100 other state and national medical/specialty societies in a collective letter addressed to Cigna urging them to reconsider this policy due to its negative impact on practice administrative costs and burdens across medical specialties and geographic regions, as well as its potential negative effect on patients—and instead, partner with these organizations on a collaborative educational initiative to ensure correct use of modifier 25.