Anthem BCBSHigh ImpactBilling Codes
[Ohio] Claims for XXX procedures billed with an E&M service must use modifier 25
Published May 3, 2026
AI Summary
Ohio providers must now add modifier 25 to all Evaluation & Management (E&M) services when billed with XXX category procedures on the same date of service. This ensures proper reimbursement for separately identifiable E&M services performed with XXX procedures.
Action Required
Immediately: Billing team must update billing system to automatically append modifier 25 to all E&M codes (99201-99499) when billed with XXX category procedures on the same date. Update encounter forms and EMR templates to remind providers. Train staff on proper modifier 25 usage to prevent claim denials.
Plan Types
All Plans
States
OH
Specialties
all-specialties