CommercialReimbursementHigh impact
[California] Reimbursement policy update: Modifiers 25 and 57: Evaluation and Management with Global Procedures
Anthem BCBS·CA·Claims & Billing
We identified it
May 3, 2026
Summary
Anthem California has updated their reimbursement policy for modifiers 25 and 57 when used with Evaluation and Management services alongside global procedures. This affects how billing teams must apply these modifiers to ensure proper reimbursement for E&M visits performed on the same day as procedures with global periods.
Action Required
Immediately: Review and update billing guidelines for modifiers 25 and 57 when billing E&M services with global procedures. Training staff must educate billing team and providers on proper modifier usage to ensure compliant claims submission and avoid reimbursement denials. Update encounter forms and billing system edits to reflect new policy requirements.