August 31, 2020

APMA submitted a letter to the medical director of Amerigroup Caritas Medicaid District of Columbia last week on behalf of members in the DC–MD–VA region who might be treating vulnerable patients covered by this plan.

Effective July 30, this new policy denies appropriate payment for evaluation and management when performed with services and/or procedures that have a 0- or 10-day global, by reducing reimbursement of the service by 50 percent. APMA has significant concerns with how this policy affects access to care, outcomes, and cost of care for your patients and Amerigroup's beneficiaries. Read the letter at www.apma.org/commentletters.

APMA is aware of the ongoing trend of payers reducing reimbursement for services when paired with the -25 modifier and is actively fighting this trend. The APMA Health Policy and Practice Committee recently formed the -25 Modifier Workgroup to help members fight these policies as well as developing educational materials and resources to ensure that the -25 modifier is being used and documented correctly. The ultimate goal of this workgroup is to ensure that payers rescind the reimbursement reduction policy as well as prevent other payers from implementing new such policies.

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