Overview of the Policy Pause
Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) have officially paused the rollout of a new reimbursement policy tied to modifier 25. The pause covers all lines of business and removes any immediate pressure on providers who bill evaluation and management (E/M) codes alongside minor procedures. Many providers had been preparing for the change since February 2026. Now, they can hold off on adjusting their billing workflows — at least until further notice.
This development is significant for clinics, hospitals, and independent practices that frequently bill same-day procedures and E/M visits together. Consequently, billing teams should understand both what the original policy proposed and what the pause means going forward.
What the Original Policy Proposed
The new reimbursement policy targeted a specific, high-frequency billing scenario. Under the original plan, BCBSM and BCN intended to reduce payment by 50% for E/M codes billed with modifier 25 when both of the following conditions applied:
- The E/M service and a minor procedure occurred on the same date of service
- The same provider billed both services for the same patient
This reduction would have applied across all product lines for claims with dates of service on or after May 1, 2026. However, that effective date no longer applies. The implementation is now on pause, and BCBSM has not announced a revised start date.
Why Modifier 25 Matters in Billing
Modifier 25 tells payers that a provider performed a separate, significant, and identifiable evaluation and management service on the same day as a procedure. Providers use it to justify billing both the visit and the procedure as distinct services. Without this modifier, payers may bundle the E/M visit into the procedure payment — reducing total reimbursement.
Therefore, the proposed 50% cut specifically targeted these combined same-day claims. Many providers in primary care, dermatology, orthopedics, and surgery rely heavily on modifier 25 to receive appropriate payment for legitimate same-day E/M services. The financial impact of the original policy would have been substantial for these specialties.
Which Plans and Providers Are Affected
The paused policy applies across all BCBSM and BCN product lines, including:
- Blue Cross commercial plans
- Medicare Plus Blue℠ plans
- BCN commercial plans
- BCN Advantage℠ plans
As a result, the pause is broad in scope. Providers serving patients under any of these plans — whether commercial or government-sponsored — do not need to change their modifier 25 billing practices at this time. All existing reimbursement rules remain in effect until BCBSM issues further guidance.
Background: How BCBSM Announced the Policy
BCBSM originally communicated this new modifier 25 policy through two formal channels. First, an article ran in the February 2026 issue of The Record under the title “Policy update: E/M codes appended with modifier 25.” That article introduced the proposed payment reduction and outlined the billing conditions it would target.
Subsequently, a provider alert posted February 26 provided clarification on several points from that article. It addressed common questions around which procedures and E/M codes fell within scope. Both communications stated that the policy would take effect on or after May 1, 2026, for all BCBSM and BCN lines of business.
Despite these earlier announcements, BCBSM has now stepped back from that timeline. The pause reflects the need for additional review before implementation moves forward.
What Providers Should Do Right Now
Currently, providers do not need to alter their modifier 25 billing practices. Since the policy remains paused, standard reimbursement processes apply. However, billing leaders should actively monitor future communications from BCBSM and BCN. When a new effective date is announced, providers will need adequate lead time to update coding workflows and train staff accordingly.
Steps to Stay Prepared
- Subscribe to Provider Alerts Weekly — BCBSM’s official weekly email delivers links to all recent provider alerts directly to your inbox
- Review the February 2026 Record article to understand the original policy intent, which may still take effect at a later date
- Brief coding and billing staff on the pause to prevent unnecessary changes to existing billing workflows
- Audit current modifier 25 usage so your team is ready to assess impact once a revised effective date is announced
Key Takeaways for Billing Teams
The pause is welcome news for providers anticipating revenue disruption. Nevertheless, teams should treat this as a temporary hold rather than a permanent cancellation. Here is a concise summary of what matters most:
- BCBSM and BCN have paused — not cancelled — the new modifier 25 policy
- The original policy proposed a 50% payment reduction for same-day E/M codes billed with modifier 25 alongside a minor procedure
- The policy covered all BCBSM and BCN product lines
- The previously announced May 1, 2026 effective date no longer applies
- No revised effective date has been communicated yet
Providers should continue monitoring BCBSM’s official channels. Moreover, they should stay prepared to implement workflow changes quickly once a new timeline emerges.
