Anthem won’t reduce E&M/CPT 25 modifier payments

The American Medical Association (AMA) reports that Anthem “will not proceed with its policy to reduce payments for E&M services reported with CPT modifier 25” and that “Anthem plans to formally notify its contracted providers within the next few days of this decision.”

“This is a huge victory for physicians,” says Medical Association of Georgia President Frank McDonald, M.D., M.B.A “This demonstrates what is possible when our profession is united in its advocacy efforts.”        

A February 23 letter from Anthem to AMA also noted that the insurer “[is committed] to continuing to work with the AMA, state medical associations, and national medical specialty societies to address physician concerns with other policies and guidelines (e.g., retrospective denial of payment for emergency room visits, restrictions on advanced imaging in hospital outpatient facilities, and the denial of payment for monitored anesthesia care or general anesthesia for cataract surgery.)”

Click for Anthem letter to AMA