Healthcare reimbursement amounts are constantly being reevaluated, and it’s no different for modifiers. Recently, the Centers for Medicare and Medicaid Services (CMS) proposed a change that would reduce the reimbursement amount for modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) by a whopping 50%.

Currently, when a procedure and an E/M service are billed together, both are eligible for full reimbursement. Under this proposed change, however, the less expensive of the two service would only be eligible for half of that original payment. According to ICD10monitor, CMS lists the following reasons for this reduction:

• Multiple payment reduction: CMS is comparing an E&M with a procedure to a surgical encounter in which multiple payment reductions are applicable.
• Efficiencies: CMS feels that there are “efficiencies” associated with an E&M encounter and procedure on the same visit that the multiple payment rule should be applied to these instances.

Understandably, many coders and physicians are less than happy with this announcement. Proper use of modifier 25 has always been a bit muddy, and CMS is not the first insurance company to attempt to halve the reimbursement. Being the giant that it is, though, CMS is less likely to back down from its decision.

Because this change has the possibility to cut thousands from the revenue cycle of the average practice or hospital, many healthcare professionals are voicing their concerns. Currently, CMS still has the option for people to submit comments on this proposal via their website at https://www.regulations.gov/docket?D=CMS-2018-007611 or by mailing them directly to CMS in Baltimore. If your workplace uses modifier 25 frequently, you stand to lose a great deal of reimbursement, so be sure to submit your opinions to CMS and let your voice be heard while there is still time.