Reimbursement Policy Update: Modifier 25
Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect
Reimbursement Policy Update: Modifier 25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service
(Policy 06-003, effective 04/01/2019)
The Anthem Blue Cross and Blue Shield (Anthem) Modifier 25 reimbursement policy provides the criteria for reimbursement for a significant, separately identifiable evaluation and management (E&M) service performed by the same provider on the same day of the original service or procedure. Effective April 1, 2019, Anthem does not allow separate reimbursement for E&Ms performed on the same day as a major surgery (90-day global period).
For additional information, refer to the Modifier 25 reimbursement policy at www.anthem.com/inmedicaiddoc.
February 2019 Anthem Indiana Provider Newsletter