MAFP Joins Effort to Challenge BCBSM’s Modifier 25 Reimbursement Reduction

MAFP along with Michigan State Medical Society, state and national specialty societies, physician organizations, and large medical groups are actively responding to a newly announced reimbursement policy change from Blue Cross Blue Shield of Michigan (BCBSM) that will significantly reduce payment for certain evaluation and management (E/M) services billed with modifier 25.

Through unified advocacy, shared specialty-specific data, and coordinated messaging, advocates are challenging the plan’s policy change, highlighting the potential impact on patient access, and advocating for appropriate reimbursement when physicians provide legitimate, separately identifiable E/M services.

The policy, outlined in the February 2026 edition of The Record, will take effect for services rendered on or after May 1, 2026. Under the new policy, BCBSM will reduce reimbursement by 50% for applicable non-preventive office/outpatient E/M services when they are billed with modifier 25 on the same date of service as a procedure with a 0-, 10-, or 90-day global surgical period. This policy applies to patients enrolled in:

• Blue Cross Blue Shield of Michigan
  
• Blue Care Network
• Medicare Plus Blue℠ (participating providers only)
• BCN Advantage℠ (participating providers only)
• Blue Cross and Blue Shield Federal Employee Program

The reimbursement reduction applies to office/outpatient E/M codes 99202–99205 and 99212–99215 when appropriately appended with modifier 25. Currently, BCBSM reimburses these E/M services at 100% of the allowed amount when billed with modifier 25 on the same day as a procedure. Beginning May 1, 2026, payment for the E/M service will be reduced by half.

According to BCBSM, the change is intended to avoid paying the practice expense component twice, once through the E/M service and again through the procedure’s global payment, consistent with what the plan describes as industry benchmarks aimed at reducing wasteful spending. The policy excludes preventive and administrative E/M services as well as emergency department E/M codes 99281–99285.

This change may disproportionately affect procedural and surgical specialties, as well as medical specialties that routinely perform office-based procedures on the same day as a separately identifiable evaluation. Practices that rely on modifier 25 to accurately reflect medically necessary, distinct E/M work may experience notable revenue reductions beginning in 2026.

MAFP will continue to work with partners to oppose this reduction and will provide updates to members as discussions progress. If you are willing to share an example of the potential impact to your practice, please email Chief Executive Officer Karlene Ketola at [email protected].