CommercialBilling CodesHigh impact
[Georgia] Claims for XXX procedures billed with an E&M service must use modifier 25
Anthem BCBS·GA·Provider Bulletin
We identified it
May 3, 2026
Summary
Georgia Anthem now requires modifier 25 to be appended when billing XXX procedures (minor surgical procedures) alongside Evaluation and Management (E&M) services on the same date. This ensures proper reimbursement for both the procedure and the separate E&M visit.
Action Required
Immediately: Billing team must update system rules to automatically append modifier 25 when XXX procedures are billed with same-day E&M services for Georgia Anthem patients. Update encounter forms and EMR templates to remind providers about modifier requirements. Train staff on XXX procedure modifier usage to prevent claim denials.