Cigna delays implementation of modifier 25 policy again

The Cigna Group is again delaying implementation of a policy that would have required the submission of medical records when using modifier 25 for all evaluation and management claims billed with CPT codes 99212-99215 and a minor procedure.

The policy had been set to go into effect May 25, and Cigna said it will "continue to review for future implementation," according to a policy update from the company on May 22.

The American Medical Association and more than 100 physician and healthcare organizations had asked Cigna to reconsider the policy, saying it would add administrative costs and burden, thereby potentially affecting patients.

The groups said in their April letter to Cigna CEO David Cordani that the policy was "extremely ill-timed and will further hamper healthcare 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. 

Cigna first notified providers about the policy in May 2022, but the company paused implementation in June to reevaluate the requirement after pushback from medical groups. Cigna reintroduced the policy in March 2023.

Becker's has reached out to Cigna and the AMA and will update this article if more information becomes available.



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