A Victory for Physicians: Cigna Delays Implementation of Medical Records Requirement

A Victory for Physicians: Cigna Delays Implementation of Medical Records Requirement

Colleagues:

Recently MSSNY began getting calls and emails from members about receipt of a letter from Cigna advising them that as of 5/25/23, any claim with the modifier 25 when billed with E/M CPT codes 99212 – 99215 must include medical records for processing.

MSSNY’s Division of Payment and Practice went right to work on behalf of our physicians and immediately brought the issue to an AMA workgroup meeting.  MSSNY, the AMA, and other organizations worked together to advocate against the implementation of this requirement, which would have added to the existing untenable administrative burden in physicians’ offices.

I am pleased to report that Cigna has updated its modifier 25 policy to announce a delay in implementing the required submission of documentation to support the use of modifier 25.

Following are further specifics from Cigna:

• Cigna is currently reevaluating this reimbursement policy update, which will delay implementation.
• Cigna will look to implement this policy later, when it can optimize the provider experience and perform additional provider education in partnership with key national medical associations.
• Cigna will communicate a new implementation date and additional details later.
• Cigna appreciates your partnership and patience and looks forward to working more collaboratively with provider partners, medical associations, and their membership to ensure that modifier 25 is used appropriately and in alignment with national guidelines and industry standards.

MSSNY will continue to fight for you and what is best for your practice.

Paul A. Pipia, MD

MSSNY President