Urology Coding and Reimbursement Podcast
Urology Coding and Reimbursement Podcast
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UCR 101: Modifier 25 - deep dive

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June 24, 2022

Mark and Scott welcome Dr. John Lin to the podcast to discuss in detail Modifier -25.

Skyline Urology to Pay 1.85M to Settle False Claims Act Allegations of Medicare Overbilling 

https://www.justice.gov/opa/pr/skyline-urology-pay-185-million-settle-false-claims-act-allegations-medicare-overbilling 

Also Corporate Integrity Agreement 

OIG Audit Modifier 25

https://oig.hhs.gov/oei/reports/oei-07-03-00470.pdf

 

NCCI Policy Manual: https://www.cms.gov/medicare/national-correct-coding-initiative-edits/ncci-policy-manual-medicare 

Chapter 7: GU System

The decision to perform a minor surgical procedure is included in the payment for the minor surgical procedure and shall not be reported separately as an E&M service. However, a significant and separately identifiable E&M service unrelated to the decision to perform the minor surgical procedure is separately reportable with modifier 25. 

Cigna:  

https://www.cmadocs.org/newsroom/news/view/ArticleId/49780/Cigna-to-require-medical-records-for-all-modifier-25-claims
Cigna’s Modifier Policies: https://static.cigna.com/assets/chcp/resourceLibrary/clinicalReimbursementPayment/medicalClinicalModifiersPolicies.html


Cigna’s Modifier 25 Policies:
https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/clinReimPolsModifiers/Notifications/Modifier_25_Significant_Separately_Identifiable_Evaluation_and_Management.pdf 

 

Horizon BCBS: Beginning on August 1, 2022

https://www.horizonblue.com/providers/news/news-legal-notices/claim-reimbursement-update-e-m-codes-appended-modifier-25 

 

BCBS of Massachusetts: Effective July 18, 2022, 


https://provider.bluecrossma.com/ProviderHome/portal/home/news/news/claims-coding-payment/all%20networks/!ut/p/z0/rZBNb8IwDIb_Sjj0OMUU6ODYsbVl0E1oApVcJtMGyEiTkkZl_PulaEP70G4c4_eJ_diU0YwyhY3YohVaoXTvFQteE38y7k6H8BwHywjms_5o6N8uAOYBfaTMAcswSO6ixIdhGkUwefLjcBHFPRj12w7i7XBgIWW5Vpa_W5pVRjei4IZU2liU5BwoS6RYGzQnDy5A7soGpavs0JSYu0wbFwi1JSUvRH4WrT0oUUhSc9OInJMv-NPuog8T_x7mD93kpRdNexAH17KrLaoCpVbcAzT5TjS8IIof63aAb9JxuqWsQru7EWqjafaT-WX598j_NJHS_bdHbfb1tRZpfTzIJYqydnzR3rnCU-lyt9n3gdWerQeymW1SO1iFnc4H0ChcIg!!/ 

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Penafian: Podcast dan karya seni yang dibenamkan pada halaman ini adalah daripada Mark Painter, Scott Painter and Dr. Ray Painter, yang merupakan hak milik pemiliknya dan tidak bergabung dengan atau disokong oleh Listen Notes, Inc.
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