AAPM&R Advocacy Efforts Result in Reversal of Anthem Modifier 25 Reduction Policy

Members & Publications


February 26, 2018

In October 2017, AAPM&R began working with a coalition of national medical specialties and state medical associations to advocate regarding our concerns with Anthem’s policy to reduce payment for evaluation and management services billed with modifier 25. 

We are pleased to report that because of this advocacy, Anthem has reversed this policy, which was scheduled to take effect March 1, 2018. 

AAPM&R recognizes that many of our members appropriately use modifier 25 when billing minor procedures with separately reportable evaluation and management services. Were this policy to have taken effect, physiatrists would have experienced a significant decrease to payment. Anthem has indicated it will notify all contracted providers regarding the policy decision in the coming days.   

Learn more about AAPM&R's Advocacy efforts. 

Legislation Introduced to Alleviate Impact of Conversion Factor Cut for 2021

Nov 09, 2020

Last month, two bills were introduced in the House proposing solutions to the estimated 10.6% Physician Fee Schedule conversion factor cut expected to go into effect January 1, 2021.  The bills offer some relief to the cut, but do not reflect a comprehensive or long-term solution.  AAPM&R has therefore chosen to remain neutral regarding these bills. 

Your Academy continues to advocate for a permanent solution to the conversion factor cut while maintaining the important payment increases to office and outpatient evaluation and management services.