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A proposed 50 percent reduction in claims submitted with modifier 25 is on the table.

The Centers for Medicare & Medicaid Services (CMS) is proposing a 50 percent reduction in reimbursement for claims submitted using modifier 25, according to Shannon DeConda, an evaluation and management (E&M) coding expert.

DeConda reported on the proposed reduction during today’s Monitor Mondays broadcast. DeConda said that with all the concerns regarding CMS’s proposed E&M reimbursement model change and documentation relaxation initiatives, many providers and stakeholders have failed to notice the other changes being floated.

“If accepted as final rule, when a 25 modifier is reported on a claim, the service with the lower reimbursement rate will be reduced by 50 percent,” DeConda told Monitor Mondays audience members. “This reduction is in addition to the proposed flat-rate E&M reimbursement proposal, representing significant financial implications for most practices and organizations treating Medicare beneficiaries.”

As reported by RACmonitor, the proposed E&M changes have continued to generate controversy. Public comment on the proposed E&M changes, found in the 2019 Medicare Physician Fee Schedule, will extend until Sept. 10.

Program Note: Register to listen to the Shannon DeConda webcast on the proposed E&M changes on Aug. 23 at 1:30 p.m. EST.


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Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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