All PlansAdministrativeMedium impact
PAP232 - Simultaneous Preventive, Evaluation and Management Services - Updated language
Blue Cross of Idaho·ID·Medical Policy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho updated policy PAP232 regarding billing for simultaneous preventive exams and evaluation & management services. The policy clarifies that providers can bill both a preventive service and a separate E/M code with modifier 25 when a medical condition is discovered during a preventive exam, provided the E/M service is significant, separately identifiable, and for a non-preventive clinical reason.
Action Required
Immediately: Billing team should review current billing practices for preventive visits where medical conditions are discovered. Ensure staff understand that modifier 25 must be attached to E/M codes when billing simultaneously with preventive services. Update encounter forms and EMR templates to remind providers to document the significant and separately identifiable nature of the E/M service and link diagnoses correctly to service lines in field 24E of CMS1500 forms.