Colorado
Provider Communications
Update regarding evaluation and management with modifier 25 same day as procedure when a prior E/M for the same or similar service has occurred (Professional)
Beginning with claims processed on or after March 1, 2019 Anthem may deny the E/M service with a modifier 25 billed on the day of a related procedure when there is a recent service or procedure for the same or similar diagnosis on record.
If you believe a claim should be reprocessed because there are medical records for related visits that demonstrate an unrelated, significant, and separately identifiable E/M service, please submit those medical records for consideration.
Featured In:
February 2019 Anthem Provider Newsletter - CO