AMA HOD adopts modifier 25 resolution

November 14, 2017

The American Medical Association (AMA) House of Delegates (HOD) has adopted a resolution that was authored by the American Academy of Dermatology delegation and Dermatology Section Council (DSC) to address insurers’ attempts to reduce reimbursement for modifier 25. The resolution, triggered by recent announcements that Anthem Blue Cross Blue Shield and Independence Blue Cross will reduce reimbursement for modifier 25 in several states, calls on the AMA to aggressively and immediately advocate through any legal means to see that insurers comply with accepted CPT coding and reimbursement guidelines.

Furthermore, the AMA President and AMA Board Chair met with the DSC to address the AADA's concerns, and stated that they would act aggressively in opposition to these types of policies.

Final language of the resolution:

RESOLVED: That our American Medical Association aggressively and immediately advocate through any legal means possible, including direct payer negotiations, regulations, legislation, or litigation, to ensure when an evaluation and management (E&M) code is appropriately reported with a modifier 25, that both the procedure and E&M codes are paid at the non-reduced, allowable payment rate.

Additionally, the AADA and state dermatologic societies sent a letter to the Blue Cross Blue Shield Association (BCBSA) highlighting concerns with BCBSA member plans' proposals to reduce reimbursement for modifier 25 in several states effective January 1, 2018. To read the letter, click here.