Blue Cross Blue Shield of Michigan has updated its policy that will reduce reimbursement for certain evaluation and management (E/M) services billed with modifier 25 on the same day as procedures.
Beginning May 1, 2026, the insurer plans to reduce payment by 50% for non-preventive E/M services billed with modifier 25 when performed alongside minor procedures with global periods of 0 or 10 days. The payer clarified that 90-day global procedures were mistakenly included in the original policy and have now been removed.
The policy applies to common office visit codes
- 99202–99205 (new patients)
- 99212–99215 (established patients).
However, preventive services, administration services, and emergency department E/M codes (99281–99285) will not be affected. Emergency room visits occurring within one calendar day and procedures with no global period are also exempt.
According to the insurer, the change is intended to prevent duplicate reimbursement of practice expenses when services occur on the same day. The policy will impact members enrolled in several BCBS Michigan plans, including commercial, Blue Care Network, Medicare Plus Blue, BCN Advantage (participating providers), and the Federal Employee Program.
Provider groups, including the Michigan State Medical Society, have expressed concern about the reimbursement reductions and continue to advocate for adjustments to the policy.
Resource: BCBS Michigan updates, clarifies policy set to cut 50% from some E/M payments with ‘modifier 25’