Comment Letter

Neurosurgery Urges Cigna to Rescind Modifier -25 Policy

  • Reimbursement and Practice Management

David Cordani
Chairman and Chief Executive Officer
The Cigna Group
900 Cottage Grove Road
Bloomfield, CT 06002

Dear Mr. Cordani:

On behalf of the undersigned organizations representing physicians and health care professionals across the country, we request that Cigna immediately rescind its policy requiring submission of office notes with all claims including evaluation and management (E/M) Current Procedural Terminology (CPT®) codes 99212, 99213, 99214, and 99215 and modifier 25 when a minor procedure is billed. Cigna recently notified network providers that payment will be denied for E/M services reported with modifier 25 if records documenting a significant and separately identifiable service are not submitted with the claim. We share Cigna’s belief that appropriate use of modifier 25 should be paid in full for both the E/M service and procedure, while inappropriate use of modifier 25 should be prevented. We urge Cigna to reconsider this policy due to its negative impact on practice administrative costs and burdens across medical specialties and geographic regions, as well as its potential negative effect on patients, and instead partner with our organizations on a collaborative educational initiative to ensure correct use of modifier 25.

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