Wisconsin
Provider Communications
Update: E&M 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 October 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.
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September 2019 Anthem Provider News - Wisconsin