The California Medical Association (CMA) announced that Blue Shield plans to rescind its recently disclosed policy that would significantly reduce reimbursement for evaluation and management (E/M) services billed with modifier 25 and a minor procedure code. CMA strongly opposed the policy and coordinated with numerous national and state specialty organizations to challenge the proposed changes.

CMA had raised serious concerns about the policy, noting that it would broadly impact physician practices and patients across California, creating a disincentive for physicians to provide efficient care for unscheduled services. In a letter to Blue Shield, CMA emphasized that the policy would result in a duplicative reduction in reimbursement, sometimes bringing the reimbursement for two services below the level for providing just the E/M service and potentially below the physician’s cost to provide the services. CMA and the American Medical Association met with Blue Shield to discuss these concerns.

Blue Shield will be sending out notices to physicians about the change.

CMA expressed appreciation for Blue Shield’s collaborative dialogue and willingness to work with the association and physicians to identify alternative strategies to address cost concerns. CMA believes Blue Shield’s decision reflects a growing recognition of the need for a different type of engagement between health plans and the physician community to improve healthcare quality, access, and affordability.