CommercialBilling CodesMedium impact
[Virginia] Claims for XXX procedures billed with an E&M service must use modifier 25
Anthem BCBS·VA·Provider Bulletin
We identified it
May 3, 2026
Summary
Virginia Anthem requires modifier 25 to be appended to evaluation and management (E&M) codes when billed with XXX procedures on the same date of service. This is a billing requirement to indicate the E&M service was significant and separately identifiable.
Action Required
Immediately: Billing team must update billing system rules to automatically append modifier 25 to E&M codes (99201-99499) when billed with XXX procedures on same date of service. Update encounter forms and provider documentation templates to remind staff of this requirement. Claims without proper modifier 25 usage may be denied by Virginia Anthem.