Health Net Joins Anthem in Decision to Rescind Proposed Modifier 25 and Emergency Services Payment Policies


In March, Health Net notified physicians of planned changes to its modifier 25 and emergency services payment policies for Medicare and Medi-Cal lines of business. The California Podiatric Medical Association (CPMA) was strongly opposed to these proposed policies. 

Once again, spearheaded by CPMA Past President Franklin Kase, DPM, Chair, Health Policy Committee, the California Podiatric Medical Association was in the forefront of the push back effort, which included working and coordinating with other state and national organizations to halt the enactment of the proposed changes, which if implemented would have cut reimbursement of an evaluation and management service with modifier 25 by 50 percent when billed with a minor surgical procedure or a preventive visit (CC.PP.052 and CC.PP.057). Additionally, Health Net planned to implement a Non-Emergent Emergency Room policy (CC.PP.053), which would have reduced reimbursement for Level 4 (99284) and Level 5 (99285) emergency services to a Level 3 (99283) reimbursement rate if Health Net deemed the diagnosis was non-emergent.

Last month, at both CPMA’s and CMA’s urging, Health Net agreed to delay implementation of the new policies until July 1, 2018, to allow time to review provider concerns with the new policies and to continue discussions with the two stakeholders.

Health Net has now informed CPMA that it will NOT proceed with implementation of its modifier -25 and emergency services payment policies in California. Health Net will be sending out an official notice to providers about the change.

The California Podiatric Medical Association appreciates the collaborative dialogue with Health Net and its willingness to work with CPMA and physicians to identify alternative strategies to address proper coding and cost concerns. 

CPMA also thanks Dr. Frank Kase for his tireless efforts on behalf of podiatric medicine, the California Podiatric Medical Association, its physician members and their patients.