Legislation has been introduced in Massachusetts that would prohibit insurers from reducing reimbursement when a Modifier 25 code is utilized. H.4338/S.810 would prevent insurers from continuing their practice of reducing payment when a physician uses a code known as “modifier 25,” which allows you to handle unscheduled, but necessary, medical procedures during an appointment for an unrelated issue. The bill is pending before the Massachusetts Health Care Financing Committee. Such reimbursement practices by insurers force patients to schedule another appointment for necessary care, thus incurring additional co-pays and deductibles, and further disadvantaging low income and geographically isolated patients.
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