Cigna says it will delay problematic modifier 25 policy, work to optimize the provider experience

May 25, 2023

Cigna has announced it will be re-evaluating the policy that would require the submission of medical records for all Evaluation and Management (E/M) claims billed with CPT 99212-99215 and modifier 25 when a minor procedure is billed.

The California Medical Association (CMA) and others in organized medicine have been urging the payor to rescind the policy since it was first announced last year, as it effectively penalizes physicians for providing efficient, unscheduled care.

CMA has also stressed to Cigna that the policy would result in significant, unnecessary administrative burdens and compliance costs for physician practices, and would waste health care dollars by creating duplicate requests.

Although Cigna has previously announced implementation delays to reevaluate the policy based on stakeholder feedback, this week the payor has indicated it will work to optimize the provider experience before implementing the policy. Cigna has also said it will work with key national medical associations to educate providers to ensure modifier 25 is used appropriately and in alignment with national guidelines and industry standards.

CMA continues to advocate for a more collaborative approach to identify alternative methodologies for cost containment that do not bluntly penalize physicians using the modifier appropriately.

Practices with questions or concerns are encouraged to contact Cigna Customer Service at (800) 88Cigna (882-4462).

Practices can also contact CMA at (888) 401-5911 or economicservices@cmadocs.org.


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