March 20, 2023

Updated APril 17, 2023

Last week, APMA joined a large number of medical specialty and other organizations in signing a letter sponsored by the AMA asking CIGNA to immediately rescind its policy requiring submission of office notes with all claims including evaluation and management (E/M) Current Procedural Terminology (CPT®) codes 99212, 99213, 99214, and 99215 and modifier 25 when a minor procedure is billed. These organizations urge CIGNA 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 our organizations on a collaborative educational initiative to ensure correct use of modifier 25. APMA will also continue to reach out to CIGNA directly to contest these policies.

APMA is aware of Cigna Healthcare’s deeply disturbing and onerous new policy, “Reimbursement policy update—Evaluation and management codes billed with modifier 25 and minor procedures effective June 11, 2023.” Under the new policy, providers must submit office notes with claims submitted with E/M CPT® codes 99212, 99213, 99214, and 99215 and a 25 Modifier when a minor procedure is billed. If a provider fails to submit this supporting documentation, the claim will be denied. Cigna also shares instructions regarding how to submit these claims and the required documentation.

APMA feels this policy is unjust and extraordinarily onerous for providers. The policy’s administrative burden distracts from providers’ ability to care for their patients and will contribute to physician burnout. APMA is already engaged with other societies and is collaborating with others to contest this egregious policy.

APMA members can find guidance regarding documentation guidelines for significant and separately identifiable E/M services at www.apma.org/25modifier.

Related Resources

APMA and CAC Engagement Coalition to Meet in Person With CMS

—

Learn More

About APMA Advocacy Diabetes & Cardiovascular Disease Public Health

APMA Collaborating with NGS CAC Representatives to Address At-Risk Foot Care LCA Changes

—

Learn More

About APMA Advocacy Diabetes & Cardiovascular Disease Public Health