CommercialReimbursementHigh impact
[Ohio] Reimbursement policy update: Modifiers 25 and 57: Evaluation and Management with Global Procedures
Anthem BCBS·OH·Claims & Billing
We identified it
May 3, 2026
Summary
Anthem Ohio updated their reimbursement policy for modifiers 25 and 57 when used with Evaluation and Management codes during procedures with global periods. This affects how E&M services are billed and reimbursed when performed on the same day as surgical or other global procedures.
Action Required
Immediately: Review current billing practices for modifier 25 and 57 usage with E&M codes during global procedures. Billing team must access the full policy at the provided URL to understand specific reimbursement changes and update billing guidelines accordingly. Train staff on proper modifier application to prevent claim denials.