After receiving a letter submitted by the American Medical Association (AMA) and more than 100 medical societies, including the American Academy of Sleep Medicine (AASM), Cigna has announced a delay in implementation of its recently revised modifier 25 policy. Modifier 25 enables reporting of a significant, separately identifiable evaluation and management (E/M) service by the same physician or other health care professional on the same day of a procedure or other service.
While it’s clear that Cigna revised this policy to address inappropriate use of the modifier, there is currently no data demonstrating inappropriate use or inexplicably high use of the modifier. Additionally, the new documentation requirements may lead to an unintended consequence of additional, unscheduled services, which will require patients and providers to schedule multiple visits if the modifier can’t be used.
Cigna is currently reevaluating this reimbursement policy update, and it has added a note to the policy so providers are aware that the implementation has been delayed. However, the payer will look to implement this policy later, when it can optimize the provider experience and perform additional provider education in partnership with key national medical associations. Cigna will communicate a new implementation date and any additional details at a later date, at which time AASM members will receive an update.
For questions about this policy, members may contact the AASM health policy team at coding@aasm.org.
