Health Net to delay modifier 25 and emergency services policy changes until July 1

CAL/AAEM News Service calaaem.news.service at gmail.com
Thu May 10 13:31:23 PDT 2018



 

May 4, 2018

Health Net to delay modifier 25 and emergency services policy changes until
July 1

 

 
<http://www.cmanet.org/news/detail/?article=health-net-to-delay-modifier-25-
and-emergency> CMAnet.org

 

Health Net has advised the California Medical Association (CMA) that it will
delay implementation of its recently announced modifier 25 and emergency
services payment policies for its Medicare and Medi-Cal lines of business
until July 1, 2018, to allow time to review provider concerns over the new
policies.  

 

Health Net first notified physicians in March of the new payment policies
set to go into effect on May 16, 2018. CMA, along with several specialty
societies, raised significant concerns with Health Net about the proposed
changes and urged that the policies be rescinded. 

 

CMA, along with the California Podiatric Medical Association, met with
Health Net representatives to request that the policies be rescinded.
Following this discussion, Health Net verbally agreed to delay
implementation so it can further review the policies and continue the
dialogue with providers about their concerns. Health Net will be sending out
an official notice to physicians about the implementation delay. 

 

The policies delayed until July 1 would: 

 

1.	Reduce reimbursement of evaluation and management (E/M) services
when billed with modifier 25 under the following circumstances:

 

*	When a minor surgical procedure code is reported on the same day as
an E/M code by the same physician, payment for the E/M code will be reduced
by 50 percent.

 

*	When a preventative/wellness exam and a problem-oriented E/M are
billed during the same encounter, payment for the problem-oriented E/M code
will be reduced by 50 percent.

 

2.	Reduce reimbursement for level 4 (CPT 99284) and level 5 (CPT 99285)
emergency room services that are billed with what Health Net deems a
non-emergent diagnosis to a level 3 (CPT 99283) contracted rate. 

 

Health Net has advised that it will, however, proceed with the May 16
implementation of the policy to no longer recognize or reimburse for
consultation codes (99241-99255). However, consultation codes billed will be
crosswalked to the appropriate E/M level code for reimbursement. 

 

CMA appreciates Health Net's willingness to delay the implementation to
allow more time to review the policy changes and further dialogue with CMA
and others. 

 

 

 

Jeff Wells
Deputy Editor, CAL/AAEM News Service

 

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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