CMA urges Cigna to reverse burdensome modifier 25 policy

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June 27, 2022
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The California Medical Association (CMA) is urging Cigna to rescind its recently announced policy that would require the submission of medical records with all evaluation and management (E/M) requests with CPT 99212-99215 and modifier 25 when an intervention minor is charged. This change effectively penalizes physicians who provide effective, unscheduled care to Cigna enrollees.

Cigna’s policy change would result in significant and unnecessary administrative burden and compliance costs for medical practices, discourage physicians from providing unscheduled services, and create duplicate claims, wasting healthcare dollars. The policy also lacks clarity about the types of products covered, is inconsistent with industry standards and CMS guidelines, and appears to violate California law.

CMA recently sent a letter outlining these concerns in detail and asking the payor to cancel the policy before the August 13, 2022 effective date.

Cigna’s new policy is too broad, requiring everything doctors billing office visit codes 99212-99215 with modifier -25 and a minor procedure code to submit medical records as a condition of payment. This creates another unnecessary administrative burden for physicians to use the modifier appropriately.

The CMA believes that a more collaborative approach to identifying alternative methods of cost containment, including training providers on good coding practices that do not outright penalize physicians using the modifier appropriately, will prove to be more effective and less costly in the long term.

Practices with questions regarding this policy update may contact Cigna Customer Service at (800) 88Cigna (882-4462).

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