Anthem Agrees to Fully Rescind Modifier 25 Policy

Anthem Agrees to Fully Rescind Modifier 25 Policy

This past fall, Anthem Blue Cross notified physicians in several states (including California) that effective January 1, 2018, it would reduce reimbursement of evaluation and management (E&M) services billed with modifier 25 by 50%. The California Podiatric Medical Association (CPMA) immediately sprang into action and coordinated with the American Podiatric Medical Association (APMA), American Medical Association (AMA), California Medical Association (CMA) and the American Association of Dermatologists (AAD), along with many other state and specialty organizations, to push back on the proposed change.

Franklin Kase, DPM

Spearheaded by CPMA Health Policy Chair Franklin Kase, DPM, FACFAS, the hard push back initially resulted in Anthem walking back the policy and agreeing to a 25% reduction instead of the original 50% and with a March1 implementation date rather than January 1.   

Believing the 25% reduction to still be unjust and onerous, CPMA continued a full-court press for the complete and total retraction of the policy. Today, Dr. Kase has announced that Anthem as agreed to fully rescind the new modifier 25 policy, saying “In the name of Harry Goldsmith, DPM, who contributed greatly to this effort – WE WON!

CPMA is hopeful that Anthem’s decision reflects a growing recognition of the need for a different type of dialogue and engagement between health plans and the physician community to improve health care quality, access and affordability.