CommercialReimbursementHigh impact
[New York] Reimbursement policy update: Modifiers 25 and 57: Evaluation and Management with Global Procedures
Anthem BCBS·NY·Claims & Billing
We identified it
May 3, 2026
Summary
Anthem New York has updated their reimbursement policy for modifier 25 (significant E&M service on same day as procedure) and modifier 57 (E&M service resulting in surgery decision) when billed with global procedures. This affects how evaluation and management services are paid when performed with surgical procedures.
Action Required
Immediately: Review current billing practices for modifier 25 and 57 usage with global procedures. Billing team must access the full policy at the provided URL to understand specific reimbursement changes and documentation requirements. Update billing system rules and staff training for proper modifier application with E&M services performed on same day as procedures.