AMA leads push against Cigna modifier 25 policy

The American Medical Association and more than 100 physician and healthcare organizations are asking Cigna to reconsider a policy they say will add administrative costs and burdens and potentially negatively affect patients.  

Cigna's policy will require the submission of medical records for all evaluation and management claims with CPT 99212-99215 and modifier 25 when a minor procedure is billed. It is set to go into effect May 25. 

The groups said in an April 18 letter to Cigna CEO David Cordani that the policy is "extremely ill-timed and will further hamper health care professionals already grappling with clinician burnout, workforce shortages, recovery from the COVID-19 public health emergency and rising practice expenses due to inflation." 

"We welcome the chance to collaborate with Cigna on alternative approaches to ensuring correct usage of modifier 25 that do not unfairly punish the majority of physicians and other healthcare professionals that appropriately code, as well as tax Cigna’s administrative systems," the groups said in the letter. 

The policy was originally set to go into effect in August but was paused following concerns voiced by the AMA and the California Medical Association. The CMA pushed back against the reintroduced policy in a March 29 letter to Cigna.

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