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Blue Shield rescinds modifier 25 policy

June 06, 2024


Blue Shield has rescinded its recently announced policy that would have significantly reduced reimbursement for evaluation and management (E/M) services billed with modifier 25 and a minor procedure code. The California Medical Association (CMA) was strongly opposed to the policy and had been working in coordination with many national and state specialty organizations to push back on the proposed changes.

CMA had expressed serious concerns with the policy change as it would have broadly impacted physician practices and patients across the state, creating a disincentive for physicians to provide efficient care for unscheduled services. In a letter to blue Shield, CMA emphasized that the policy would have also resulted in a duplicative reduction in reimbursement that in some cases would have brought reimbursement for two services below the reimbursement level for providing just the E/M service, and potentially below the physician’s cost to provide the services. CMA, along with the American Medical Association, also met with Blue Shield to discuss the concerns with the policy.

Blue Shield has sent out notices to physicians about the change.

CMA appreciates the collaborative dialogue with Blue Shield and its willingness to work with CMA and physicians to identify alternative strategies to address cost concerns. We believe Blue Shield’s decision reflects a growing recognition of the need for a different type of engagement between health plans and the physician community to improve health care quality, access and affordability.

 

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