Cigna again delays plan to require more modifier 25 documentation

For the second year in a row, health insurer Cigna has delayed a proposal to require more documentation for modifier 25 amid opposition from the American Academy of Family Physicians (AAFP) and other groups.

The company had announced that the requirement would take effect May 25 this year, and apply to evaluation and management (E/M) visits with a minor procedure on the same date. But just days before the go-live date, the company updated its modifier 25 policy by adding a red-text banner at the top that states, “Cigna will delay the implementation to require the submission of documentation to support the use of modifier 25 when billed with E/M CPT® codes 99212 – 99215 and a minor procedure. Cigna will continue to review for future implementation.” The delay was also noted under the Policy History/Update section.

Cigna hasn’t released a formal announcement about the delay, but its representatives have privately communicated that they:

• Are currently reevaluating the policy change, which will delay implementation.
• Will look to implement this policy later, when they can optimize the clinician experience and perform additional clinician education in partnership with key national medical associations.
• Will communicate a new implementation date and additional details later.
• Look forward to working more collaboratively with clinician partners, medical associations, and their membership to ensure that modifier 25 is used appropriately and in alignment with national guidelines and industry standards.

The modifier 25 policy change was originally announced in 2022, but Cigna delayed it then following national and state medical society opposition. The AAFP continues to advocate against its implementation, arguing that it negatively impacts patient care and places unnecessary burden on physicians and their care teams.

— Brennan Cantrell, AAFP Commercial Health Insurance Strategist

Posted on May 26, 2023