Health Net, insurer in three states, cancels modifier 25 cut
One more private payer has decided to rescind its planned policy of applying a 50% reduction to E/M codes with modifier 25 appended. Health Net, which offers a variety of insurance plans in Arizona, California, and Oregon announced that it will cancel the policy before it takes effect.
Modifier 25 (significant, separate E/M, same day/patient) is appended to E/M codes so that they will be paid when billed in the same encounter as a minor procedure. Health Net was also planning to cut the reimbursement emergency department E/M codes 99284 and 99285 down to the reimburse rate of the mid-level code 99283 if it “deemed the diagnosis was non-emergent.” This policy is also getting the axe along with the modifier 25 cut.
In announcing its decision, Health Net cited the impact of advocacy from state medical societies, particularly the California Medical Association (CMA), which argued that modifier 25 cut would ultimately result in more inconvenience and worse outcomes for patients. The CMA initially urged for a delay to the modifier 25 and ED code policies, which Health Net agreed to. Then, upon a review of “provider concerns” and a “collaborative dialogue,” Health Net went a step further and shelved both policies.
The payer has pledged to work with CMA and other state associations, along with their member physicians, to “identify alternative strategies to address proper coding and cost concerns.”
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