MAFP Challenges BCBSM’s Modifier 25 Reimbursement Reduction, Seeks Member Examples of Impact

MAFP, along with Michigan State Medical Society, several state and national specialty societies, and physician organizations, recently responded 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. You can read our letter here. 

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 decrease by 50%.

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. This adjustment aligns with industry benchmarks designed to reduce 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 is gathering information, data, and feedback from members to strengthen its rationale for rescinding the policy change. If you are willing to share an example, please email Chief Executive Officer Karlene Ketola at [email protected].