CPMA Front-and-Center in Physicians’ Fight Against New Anthem Modifier -25 Payment Reduction Policy


Anthem Blue Cross recently notified physicians in several states (including California) of upcoming changes to the payor’s reimbursement policies and claims editing software, called ClaimsXten. As part of the policy changes scheduled to become effective on January 1, 2018, Anthem will begin reducing reimbursement of evaluation and management (E/M) services 
billed with Modifier -25 under the following circumstances:

• When a minor surgical procedure code (0 or 10-day global period) is reported on the same day as an E/M code by the same physician, payment for the E/M code will be reduced by 50 percent.

• When a preventative/wellness exam and a problem-oriented E/M are billed during the same encounter, payment for the problem-oriented E/M code will be reduced by 50 percent.

Concerned with the adverse impacts of this new policy upon Members, the California Podiatric Medical Association (CPMA) is coordinating with the California Medical Association (CMA), the California Orthopaedic Association (COA), the American Association of Dermatologists (AAD), the American Medical Association (AMA), the American Podiatric Medical Association (APMA), along with many other state and specialty organizations in an organized, coordinated push back on the proposed change.

CPMA has been a prominent voice of opposition in the Coalitions’ early talks with Anthem on the issue. CPMA Past President Franklin Kase, DPM, Chair, Health Policy Committee has been key in establishing a direct channel of communication between the Coalition members and Anthem’s Medical Director on the Modifier -25 matter. Talks are ongoing.

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