Anthem Agrees to Fully Rescind Modifier 25 Cuts

February 23, 2018

In December, the New Hampshire Medical Society alerted its member physicians that Anthem had adjusted its proposed policy to reduce payments for evaluation and management (E&M) codes appropriately reported with a Current Procedural Terminology (CPT) modifier 25 by 25% instead of 50%, as originally planned. 

In response, the Medical Society committed to continue voicing its strong objections to this unwarranted reduction in physician payment, as well as work with the American Medical Association, other state medical associations and national medical specialty societies to challenge the revised policy prior to its scheduled implementation on March 1, 2018. 

We are pleased to share the letter from Anthem EVP & CCO Craig E. Samitt, MD, MBA, to AMA Board Chair-Elect Jack Resneck, Jr., MD, indicating that the company will not proceed with its policy to reduce payments for E&M services reported with CPT modifier 25. 

Anthem plans to formally notify its contracted providers within the next few days of this decision. Additionally, Anthem has expressed commitment to continuing to work with the AMA, state medical associations, and national medical specialty societies to address physician concerns with other policies and guidelines. 

As you are aware, concerns also have been raised regarding Anthem’s policies on the retrospective denial of payment for emergency room visits, restrictions on advanced imaging in hospital outpatient facilities, and the denial of payment for monitored anesthesia care or general anesthesia for cataract surgery. 

The Medical Society is hopeful that Anthem’s decision reflects the growing recognition of the need for a different type of dialogue and engagement between health plans and the physician community to improve health care quality, access, and affordability.

For further information, please contact: James Potter, Executive Vice President at 603.224.1909 or