[Virginia] Claims for XXX procedures billed with an E&M service must use modifier 25

By May 1, 2026: Billing team must update billing software to automatically append modifier 25 to all E&M claims billed with XXX procedures for Anthem Virginia Medicare Advantage plans. Providers must document in clinical notes that the E&M service is significant and separately identifiable, excluding procedure work and staff supervision. Update encounter forms and provider training materials to emphasize that documentation must support a distinct E&M beyond the usual procedure work. By July 1, 2026: Be prepared for claims to be subject to clinical review for medical necessity validation. Failure to include modifier 25 or insufficient documentation supporting a separate E&M service will result in claim denials or post-payment recoupment.