Modifier 25

INFORMATION ABOUT MODIFIER 25 AND CODING

Information and guidance regarding three extremely active payment and compliance issues:

1. Audit requests regarding OMT services reported on the same date of service as an office visit, along with the use of the Modifier-25.
2. Audit requests related to coding higher level Evaluation and Management (E/M) services; often linked to the increase in use of electronic health records, and;
3. Pay-for-performance and other quality recognition programs requirements for physicians to justify any practices that may cause them to be considered practice (cost) outliers.

UPDATED 3/30/2023

This information was provided by AMERICAN OSTEOPATHIC INFORMATION ASSOCIATION (AOIA), Physician Services Department

Physicians Services of the AOIA wanted to provide you with the attached revised Cigna M25 policy. The major change is Cigna is requiring office notes for CPT codes 99212-99215 and modifier 25 when a minor procedure is billed.

The updated Cigna policy is scheduled to become effective nationwide on May 25, 2023.

The records can be submitted via:

• dedicated fax number (833) 462-1360
• email [email protected]
• U.S. mail
• electronically through the Cigna EDI approved vendor

Please direct any questions to [email protected].