Re: AmeriHealth Policy #03.00.06n: Modifier 25
Dear Mr. Hilferty and Mr. Munoz:
The staff of the Medical Society of New Jersey spoke with Dr. Frank Urbano of AmeriHealth NJ and Dr.
Virginia Calega of Independence Blue Cross (IBC) on November 2, 2017. We discussed multiple concerns
regarding the above named policy that were outlined in our September 15, 2017 letter, attached. We
continue to have concerns about this policy change. The following concerns are shared by the undersigned
medical and specialty societies.
Benchmark Data
AmeriHealth previously stated that Truven Health Analytics showed that the number of AmeriHealth
payments for claim lines including modifier 25 in New Jersey were 10% higher than the Truven benchmark
and that this led to the adoption of the policy drastically reducing payment for certain evaluation and
management (E&M) codes appended with modifier 25. We again ask that AmeriHealth/ IBC share this
data, so that we can better understand the rationale behind the implementation of this policy.
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Read full letter here
