American Society of Plastic Surgeons
For Consumers

STATE | ASPS Opposes BCBS of Rhode Island's Arbitrary Reduction of Codes Utilizing Modifier -25

On December 13, the American Society of Plastic Surgeons along with the American Academy of Dermatology Association and numerous other state and federal specialty societies submitted a letter to Blue Cross Blue Shield of Rhode Island (BCBS RI) to urge the company to reconsider its newly revised policy on Modifier -25. The policy denies appropriate payment for Evaluation and Management (E/M) services billed with Modifier -25 by arbitrarily reducing payment for those services by 50%.

The intent of modifier -25, according to Current Procedural Terminology (CPT) guidelines, is to describe a significant, separately identifiable, and medically necessary E/M service performed on the same day as a procedure outside of the global fee concept. Providing medically necessary and distinct services on the same date allows physicians to provide effective efficient and high quality care. In many cases, this can result in not only saving patients a return visit but the cost of additional copays as well.

Rhode Island state medical specialty societies contacted BCBS RI to ask for a 90-day implementation delay in the policy to allow time for their offices to review and determine the appropriateness of the policy, as well as its impact on Rhode Island physicians and patients. The request has been denied.

ASPS has asked BCBS of Rhode Island to provide a rationale that justifies the implemented 50% reduction, a report of the costs savings generated by this policy, and have welcomed BCBS RI to engage in an open dialogue about this troubling issue. If you have experienced issues in your state related to the use of Modifier -25, please notify ASPS as soon as possible.

Read ASPS's Comments Opposing BCBS RI's Reduction of Modifier -25