Policy Update: Modifiers 25 and 57 (Policy G-06003, effective 04/01/2023)

Material Adverse Change (MAC)

Beginning with dates of service on or after April 1, 2023, Empire BlueCross BlueShield HealthPlus will update the Modifiers 25 and 57 policy to not allow reimbursement for CPT code 99211 when appended with Modifier 25 except for vaccine administration.

Based on the descriptions of both Modifier 25 and CPT^® 99211, the Evaluation and Management must be separately identifiable, and CPT 99211 is not a separately identifiable service.

In addition, the policy titled Modifiers 25 and 57: Evaluation and Management with Global Procedures will be renamed to Modifiers 25 and 57.

For additional information, please review the Modifiers 25 and 57 reimbursement policy at https://providerpublic.empireblue.com.