Reimbursement Policy Update: Modifier 25

Anthem Blue Cross and Blue Shield

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.

 

www.anthem.com/inmedicaiddoc

^{Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.}