Physicians should be able to select the E/M code that accurately reflects the documented care provided, without having that code automatically reduced based primarily on an insurer’s algorithm or payment policy. The burden of appealing incorrectly reimbursed claims falls squarely on the physician and can result in substantial uncompensated time spent fighting for what is rightly owed rather than on direct patient care. 

We have seen Blue Cross Blue Shield of Montana, Texas, Oklahoma, New Mexico, and Illinois implement automatic downcoding for higher-intensity E/M codes since July. There are likely other payers doing something similar.

Thankfully, we have a path forward to stop this predatory practice. Earlier this year, the Illinois governor signed into law a ban on automatic downcoding, but that law does not go into effect until 2028. Lawmakers in other states can pass a similar law. The momentum is on the side of physicians to stop this practice, but we need your help. 

Please contact your state lawmakers today and urge them to support protections against automatic downcoding of appropriately documented E/M services.

We have made it easy to act. Simply use the pre-written message, personalize it if you wish, and send it to your state legislators.

Thank you for speaking up for fair reimbursement and ensuring physicians can provide the level of care their patients need.