Advocacy win: Blue Cross Blue Shield of North Carolina to rescind modifier 25 policy

As a direct result of the AADA’s advocacy, Blue Cross Blue Shield of North Carolina (BCBS NC) is rescinding its modifier 25 payment reduction policy.

Without AADA’s advocacy, the policy would have gone into effect July 10 and reduced payment for non-preventive evaluation and management services by 50% when billed with a procedure code with a 0- or 10-day global surgery period. The Academy opposes reimbursement policies implemented by insurance companies that reduce payment when modifier 25 is appropriately documented.

North Carolina Dermatology Association (NCDA) members reported that they received no notification of the policy other than seeing a posting on the carrier’s website. The AADA immediately jumped into action and coordinated advocacy responses with the NCDA, the American Medical Association (AMA), and the North Carolina Medical Society.

Learn more about the Academy’s private payer advocacy efforts.