Cigna will not move forward with implementation of its modifier 25 policy

September 27, 2022
Area(s) of Interest: Practice Management 

Earlier this year, Cigna had announced a policy to require the submission of medical records with all Evaluation and Management (E/M) claims with CPT 99212-99215 and modifier 25 when a minor procedure was billed as a precondition of payment. The California Medical Association (CMA) sent a letter to Cigna outlining its concerns, urging the payor to rescind the policy that effectively penalized physicians for providing efficient, unscheduled care to Cigna enrollees.

In its letter, CMA outlined that the policy would result in significant, unnecessary administrative burden and compliance cost to physician practices, would disincentivize physicians from providing unscheduled services and would create duplicate requests thus wasting health care dollars. The policy also lacked clarity on product types impacted, was inconsistent with industry standards and CMS guidance, and appeared to violate California law.

As a result of CMA advocacy, Cigna announced in July it was reevaluating the policy and delaying implementation. Cigna also agreed to meet with CMA and the American Medical Association (AMA) to discuss further.

Since the meeting, Cigna has advised CMA and AMA that it does not plan to move forward with implementation of this policy at this time. CMA appreciates Cigna’s willingness to listen to physician feedback regarding the policy.


Was this article helpful?    
Download the New CMADocs app!

Download the new CMADocs app!

CMA's new mobile app lets you connect with your colleagues and engage with CMA content!  Download the "CMADocs" app today from the Apple or Google Play app stores for daily news updates, events calendar, resource library and more.

Latest News

Load More