Academy secures wins with private payers

As a direct result of AADA advocacy, Regence Blue Cross Blue Shield (BCBS) rescinded its modifier 25 payment reduction policy.

Without strong advocacy by the Academy and state dermatology and medical societies, the policy would have gone into effect on March 1, resulting in reduced payment for non-preventive E/M services by 50% when billed with a procedure code with a 0- or 10-day global surgery period. Upon learning of the proposed policy, the AADA immediately initiated coordinated advocacy responses with state derm societies in Idaho, Oregon, Utah, Washington, and the respective state medical societies.

The Academy and the state dermatology societies demanded that Regence BCBS not enforce the carrier’s recent modifier 25 policy change that would reduce payment by 50%.

Additionally, as a direct result of AADA’s advocacy, Aetna changed its edits for modifier 59 when reported with Mohs surgery. Effective Jan. 1, 2025, additional reimbursement may be provided when reporting evidence of a separate lesion for pathology CPT codes 88300–88309 and CPT codes 88331–88334 when billed on the same date of service as Mohs micrographic surgery CPT codes 17311–17315 using modifier 59.

Learn more about the Academy’s payer advocacy efforts.