Local News

Health Net Rescinds Modifier 25 Change

In response to opposition led by the California Medical Association (CMA), Health Net has announced that it will not proceed with implementation of its proposed reduction in modifier 25 and emergency services payments. Health Net will be sending out an official notice to physicians about its policy reversal. Additionally, Health Net expressed a commitment to work with CMA and others to implement an educational program focused on providing data and feedback to physicians, as well as information on proper coding practices for emergency department services. CMA met with Health Net and followed up to request rescission of the changes, which would have cut reimbursement of E/M services with modifier 25 by 50 percent and reduced reimbursement for Levels 4 and 5 emergency services to a Level 3 rate if Health Net deemed the diagnosis was non-emergent. For more information, go to http://www.cmanet.org/news/detail/?article=health-net-to-rescind-modifier-25-and.