AACU on updates to Cigna Modifier 25 policy

As you may know, Cigna recently updated its Modifier 25 – Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service policy to require 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 will deny payment for E/M services reported with modifier 25 if records documenting a significant and separately identifiable service are not submitted with the claim beginning 5/25/23 or 6/11/23, depending on state.

The AACU has strong concerns regarding this policy and its associated administrative waste and burdens and is working with the AMA federation to request that Cigna rescind its modifier 25 policy and partner with medical organizations on an educational initiative on correct use of the modifier. If you have questions, please contact Kristin Jimison.