Delayed: Cigna’s Modifyer 25 Policy Update NOT Happening

UPDATE, May 24, 2023

On Monday, May 22, Cigna announced that they would “delay the implementation to require the submission of documentation to support the use of modifier 25 when billed with E/M CPT® codes 99212 – 99215 and a minor procedure. Cigna will continue to review for future implementation.”

Last month, Cigna notified network providers that it would deny payment for E/M services reported with modifier 25 if records documenting a significant and separately identifiable service were not submitted with the claim. The AMA and more than 100 other provider associations, including the Arkansas Medical Society, voiced concerns to Cigna and urged them to reconsider the policy due to its negative impact on practices.

AMS executive vice president David Wroten said, “This was a bone-headed policy that threatened to create a whole new level of administrative hassles for physicians and treatment delays for patients. AMS is extremely gratified that CIGNA heard our concerns and acted responsibly. Our thanks to AMS members and clinic managers for bringing this issue to our attention.”

AMS held an informational webinar in April with Cigna representatives who answered questions regarding the policy change and member clinic administrators were able to voice their concerns on the upcoming changes.

Recorded on April 20, 2023: To view the recorded webinar, click on the video button below.

Cigna Handouts

Cigna Reimbursement Policy Update – Modifier 25.PDF

Letter – Policy Update-EMModifier 25 Minor Procedures.PDF

Cigna is still compiling a FAQ document and we will share that with you all as soon as it is completed and shared with us.