All PlansBilling CodesHigh impact
[Ohio] Claims for XXX procedures billed with an E&M service must use modifier 25
Anthem BCBS·OH·Provider Bulletin
We identified it
May 3, 2026
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.