News & Media
BCBSM Announces Reimbursement Reduction for Non-preventive E/M Services Billed with Modifier 25
Blue Cross Blue Shield of Michigan (BCBSM) has announced a significant reimbursement policy change affecting non-preventive evaluation and management (E/M) services billed with modifier 25 when performed on the same date of service as a procedure. The new policy was outlined in the February 2026 edition of The Record.
Effective for services rendered on or after May 1, 2026, BCBSM will reduce reimbursement for applicable E/M services by 50% when they are billed with modifier 25 alongside a procedure that has a 0, 10, or 90 day global surgical period.
- 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 the 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. Under the new policy, 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, which aligns 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.
The Michigan State Medical Society (MSMS) is aware of this policy update and questions BCBSM’s rationale for reducing payment for modifier 25 E/M services. MSMS is actively engaging with BCBSM to challenge the accuracy of the plan’s assumptions, highlight the impact on patient access, and advocate for appropriate reimbursement when physicians provide legitimate, separately identifiable E/M services.
MSMS will continue to work with affected specialty societies to reverse this policy and share updates as discussions progress. In the meantime, if you have questions or are willing to share an example of the potential impact to your practice, please email Dara J. Barrera, MSMS Director of Health Quality, Equity and Technology at djbarrera@msms.org.