CommercialBilling CodesHigh impact
03.00.06ad, Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
Independence Blue Cross·Cardiology, Neurosurgery, Urology +1 more·Coding
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy 03.00.06ae (effective 01/01/2026) to reflect CPT/HCPCS code changes for 2026. Nine CPT codes received narrative revisions and 15 codes were removed from the Modifier 25 policy. The core guidance on when to append Modifier 25 to E&M services remains unchanged, but billing teams must update their code lists and system rules to reflect the removed codes.
Action Required
By 01/01/2026: Billing team must update system code lists to reflect CPT/HCPCS changes in IBX policy 03.00.06ae. REMOVE the following codes from Modifier 25 billing rules and templates: 33889, 33891, 37220, 37221, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 55700, 91122, 92975. VERIFY narrative revisions for: 10040, 55705, 61624, 61626, 92920, 92924, 92928, 92941, 92943 against the full policy attachment. Update billing software to enforce the revised code list. Providers should be notified that claims with Modifier 25 for deleted codes will be denied. Failure to implement changes by the effective date will result in claim denials and potential rework.