CommercialBilling CodesMedium impact
[California] Claims for XXX procedures billed with an E&M service must use modifier 25
Anthem BCBS·CA·Provider Bulletin
We identified it
May 3, 2026
Summary
California Anthem plans now require modifier 25 when billing E&M services with XXX procedures on the same date. This ensures proper reimbursement for both the evaluation/management service and the procedure.
Action Required
Immediately: Billing team must update billing system rules to automatically append modifier 25 to E&M codes when billed with XXX procedures for California Anthem patients. Update encounter forms and provider billing guidelines to reflect this requirement. Train staff on proper modifier 25 usage to prevent claim denials.