News & Media
BCBSM/BCN Clarification When Billing Evaluation & Management Service on Same Day as a Preventive Medicine Service
For the past year, BCBSM/BCN policy has allowed for reimbursement for a problem-focused evaluation and management (E/M) service at 50 percent of the physician fee schedule when performed on the same date of service as a preventive medicine service. The preventive medicine service is reimbursed in full.
- Preventive Medicine codes are 99381 – 99387, 99391 – 99397, 99401 – 99404, 99406 – 99409, and 99411 – 99412
- E/M codes are 99202 – 99215, 99211 – 99215, 99341 – 99345, and 99347 – 99350
Modifier 25 must be appended to the problem-focused E/M code to receive proper reimbursement. It is important to remember that modifiers should only be used if the documentation supports the use of a modifier.
In BCBSM’s July 2025 The Record article, Clarification on when billing E/M code with preventive visit is appropriate, BCBSM noted that “there has been some confusion as to when it’s appropriate to use this policy, as well as when the member should be informed that the extra code is being billed.” The article provides clarification on when to bill both an E/M and preventive visit on the same date of service, as well as examples of situations where such billing may or may not be supported.
Physicians and other health care professionals may also be interested in viewing MSMS’s on-demand webinar, Practice Management Webinar Series: Evaluation and Management Services, Efficient Compliant Documentation. This webinar is intended to help you enhance your ability to determine the level of service for all E/M services and related compliant and efficient documentation. MSMS members are able to access this and other education programs for free as a member benefit.