Blue Cross Blue Shield Michigan has clarified their policy surrounding a modifier applied to certain outpatient surgical codes.
In February, BCBS Michigan released a new reimbursement policy surrounding modifier 25. In the initial announcement, BCBS stated that beginning May 1, it would change its policy surrounding non-preventive evaluation and management services appended with modifier 25 billed on the same date of service as procedure codes that have a global surgical period of zero, 0 or 90 days for services rendered on May 1 or after.
The change would reduce reimbursement for these E/M services by 50%. This would apply to patients enrolled in BCBS Michigan, Blue Care Network, Medicare Plus Blue, BCN Advantage and BCBS Federal Employee Program. In changing this policy, BCBS said it would no longer reimburse for the practice component twice. This update would apply to E/M codes 99202 to 99205 and 99212 to 99215.
In the initial update, BCBS said that when an E/M service appended with modifier 25 was submitted for the same date of service as another procedure code or codes that represent services that have a global surgical period of zero, 10 or 90 days, their claims processing system considers the E/M service at 100% of the fee for the code.
After receiving pushback from the Michigan State Medical Society, specialty groups and individual physicians BCBS issued a clarification. BCBS revised the policy to remove the 90-day global surgical period. It also further defined a “minor procedure” as having a global surgical period of either zero or 10 days, often performed in the office or outpatient setting and being general low-risk and minimally invasive. It also clarified that the modifier 25 should be used if the patient’s condition requires “a significant, separately identifiable E/M service above and beyond the usual pre-operative and post-operative care associated with the minor procedure performed.”
In a March 5 news release, the Michigan State Medical Society expressed disappointment that the “across -the-board 50% reduction” to the specified office and outpatient E/M codes remained in place, stating it would continue to seek a rescindment of the new policy.
“While the removal of the 90-day global period from the policy represents a clarification, the reduction in reimbursement for modifier 25 services associated with minor procedures remains a significant concern for many specialties,” MSMS said in the release. “Practices that routinely provide medically necessary, separately identifiable E/M services on the same day as office-based procedures may still experience meaningful revenue reductions beginning in 2026.”
