Cigna to require medical records for all modifier 25 claims

Doctor and patient discussing medical exam results while sitting at the desk in clinic, close-up. Male physician using clipboard for filling up medication history record of young woman

In late May, Cigna announced that it will begin requiring the submission of medical records with all Evaluation and Management (E/M) claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed.

IModifier 25 allows separate payment for a significant, separately identifiable E/M service provided on the same day as a minor procedure or other reported health care service. The updated Cigna policy – Modifier 25-Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service – will become effective nationwide on August 13, 2022. Failure to submit the required medical records will result in a denial of the E/M service.

IThe California Medical Association (CMA) has serious concerns with Cigna’s policy change as it will result in significant unnecessary administrative burden and cost to practices to comply, will be a disincentive for physicians to provide unscheduled services and is inconsistent with industry standards. The policy may also be inconsistent with California law.

ICMA and the American Medical Association are reaching out to Cigna regarding our concerns.

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

IPractices can also contact CMA at (888) 401-5911 or economicservices@cmadocs.org.

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