Medicare Advantage carrier slashes E/M payments in half

by Richard Scott on Jul 31, 2017

Some practices that frequently report E/M services with modifer 25 (Significant, separately identifiable E/M service) are on track to face a dramatic pay reduction.

Effective Aug. 1, Independence Health Group plans to reimburse modifier-25-appended E/M services at 50% of fee schedule rates, according to payment policy that the insurer, which operates Medicare Advantage and private plans in 25 states, released on its website.

Take a look at the details:

Updated policies on Modifier 25

Date effective	Policy update
Aug. 1, 2017	When modifier 25 is appropriately appended to an evaluation and management (E/M) service and is submitted on the same date of service, by the same professional provider or other qualified health care provider, as a minor procedure, the E&M service is reimbursed at 50 percent of the applicable fee schedule amount.
Aug. 1, 2017	When modifier 25 is appropriately appended to a problem-focused E/M service and is submitted on the same date of service, by the same professional provider or other qualified health care provider, as a preventive E&M, the problem-focused E&M service is reimbursed at 50 percent of the applicable fee schedule amount.

Source: Independence Medical Policy Portal, http://bit.ly/2u4RwL8

Coding and billing experts that Part B News contacted shared their reactions, which ranged from outrage to exasperation.

Does the revised policy affect you? What do you think about it? Comment below or send your thoughts by email.