Academy secures wins with private payers

The Academy works with private payers to alleviate administrative burdens for dermatologists, maintain appropriate reimbursement for furnished services, and ensure patients can access covered quality care.

In 2025, the Academy secured wins on several payer policies:

Modifier 25: Regence BCBS

As a direct result of AADA advocacy, Regence Blue Cross Blue Shield (BCBS) rescinded its modifier 25 payment reduction policy.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 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 dermatology societies in Idaho, Oregon, Utah, and Washington, as well as the respective state medical societies.

Modifier 59: Aetna

As a direct result of AADA’s advocacy, Aetna changed its edits for modifier 59 when reported with Mohs surgery. Additional reimbursement may now 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.

E/M downcoding: Cigna (California)

Cigna paused implementation of its “Evaluation and Management Coding Accuracy” reimbursement policy in California as a result of inquiries to state regulators about the policy’s legality.

The policy, originally scheduled to take effect Oct. 1, 2025, would have allowed Cigna to automatically downcode higher-level E/M services whenever the plan determines that documentation does not support the billed level. These decisions would be required to file an appeal and submit medical records by fax — creating unnecessary administrative burdens and costs.

The AADA is involved in ongoing discussions with the carrier on its program to mitigate the impact on dermatologists in California.

Home-based light therapy coverage: Elevance

As a result of AADA’s advocacy, Elevance Health revised its policy to cover home-based light therapy for vitiligo. Previously, coverage was limited to psoriasis. This change followed coordinated efforts by the Academy, including feedback from AADA-identified subject matter experts and a formal correspondence to the carrier. As a result, Elevance Health now considers home-based light therapy for vitiligo medically necessary when certain criteria are met.

Learn more about the Academy’s private payer advocacy efforts.