Work with the AMA leads to Anthem fully rescinding modifier -25 cuts

The College's Advocacy Council has been working with the AMA and other medical societies to roll back the Anthem cuts to modifier -25. We received information on February 23, 2018 that our advocacy efforts have been successful.

The AMA received a letter from Anthem indicating that the company will not proceed with its policy to reduce payments for E&M services reported with CPT modifier -25. Anthem plans to formally notify its contracted providers within the next few days of this decision.  Additionally, Anthem has expressed commitment to continuing to work with the AMA, state medical associations and other national medical specialty societies to address physician concerns with other policies and guidelines.

The AMA recognized and appreciated the strong advocacy efforts that the College and other medical organizations invested in this issue over the past few months. We would like to specifically thank our AMA delegate, Alnoor Malick, MD, FACAAI, and alternate delegate, John Seyerle, MD, FACAAI, for their involvement.

The College and AMA believe that Anthem's decision reflects the growing recognition of the need for a different type of dialogue and engagement between health plans and the physician community to improve health care quality, access, and affordability.


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Billing, Coding & Payments