Several Managed Care Organizations have issued directives that the evaluation and management (E&M) codes will be paid at 50% when used with modifier 25. This issue affects all physicians and not just allergists. To help address this, the ACAAI’s AMA Delegation brought this issue up at the AMA’s Interim Meeting. Although the initial request was to amend an existing AMA policy, with the help of the AMA’s Council on Medical Service and many other state and national medical specialty society delegations, the final result was a new and strengthened policy: “That our American Medical Association aggressively and immediately advocate to ensure when an evaluation and management (E&M) code is appropriately reported with a modifier 25, that both the procedure and E&M codes are paid at the non-reduced, allowable payment rate.”
This is welcome news and is the second time in the recent past that the AMA has backed up the ACAAI. Prior to this it was with the USP Compounding Rules and the FDA’s Draft Guidance on Insanitary Compounding.
As we continue to face increasing pressures from various external forces on our abilities to practice allergy and medicine in general, it is important that our membership support the AMA by becoming members of this organization.
If your practice experiences any reduction of E&M payments when using modifier 25, now or in the future, please let the Advocacy Council know of the circumstances.