All PlansBilling CodesMedium impact
[New York] Claims for XXX procedures billed with an E&M service must use modifier 25
Anthem BCBS·NY·Provider Bulletin
We identified it
May 3, 2026
Summary
For New York providers, when billing XXX procedures together with an Evaluation and Management (E&M) service on the same date, modifier 25 must now be appended to the E&M code. This ensures proper reimbursement for both the procedure and the separate E&M service.
Action Required
Immediately: Billing team must update billing system rules to automatically append modifier 25 to E&M codes (99201-99215, 99221-99239, 99241-99255, 99281-99285) when billed with XXX procedures on the same date of service. Update encounter forms and EMR templates to remind providers. Train staff on proper modifier 25 usage. Claims without modifier 25 may be denied or have the E&M service not reimbursed.