Following months of targeted advocacy efforts, the American Academy of Dermatology Association (AADA) worked closely with Anthem Blue Cross Blue Shield of Kentucky and its parent company, WellPoint Inc., to reverse its new policy that, since Jan. 1, has reduced reimbursement by 50 percent for evaluation and management (E/M) services billed with modifier 25 in conjunction with procedure codes.

Beginning June 1, WellPoint will reimburse at 100 percent of the allowable amount for these E/M codes, rather than 50 percent of the allowable amount. However, WellPoint will maintain the 50 percent reduction for E/M codes billed with a modifier 25 with a preventive visit code.

The AADA reminds members that claims for an E/M visit and a separate procedure on the same date requires both services to be medically necessary and adequately documented, and that the modifier -25 should be added to the E/M code. The E/M service should reflect work above and beyond what is included in the procedure. 

The AADA collaborated with dermatologists at the state level, as well as with the Indiana State Medical Association, the Indiana Academy of Dermatology and the Kentucky Medical Society, to achieve this result.