Blue Cross Blue Shield of Michigan (BCBSM) recently clarified its controversial Modifier 25 reimbursement policy. However, the clarification falls short of what Michigan physicians need. The core problem remains: a sweeping 50% reduction to office and outpatient Evaluation and Management (E/M) codes billed with Modifier 25 on the same day as a minor procedure. The Michigan State Medical Society (MSMS) continues its aggressive push to have this policy fully rescinded.
What Is BCBSM’s Modifier 25 Policy Change?
Effective for claims dated May 1, 2026, BCBSM will reimburse applicable E/M codes at only 50% of the contracted rate. This applies when physicians bill codes 99202–99205 (new patients) or 99212–99215 (established patients) alongside Modifier 25 on the same calendar date as a minor procedure.
What Qualifies as a Minor Procedure?
A minor procedure falls under a 0- or 10-day global surgical period. It typically includes:
- The procedure itself
- Routine pre- and post-operative care
- Related Evaluation and Management services
- Low-risk, minimally invasive office or outpatient treatments
Importantly, the minor procedure itself continues to be reimbursed at the full contracted rate. Only the separately identifiable E/M service faces the cut.
How MSMS Is Fighting Back
MSMS responded swiftly and forcefully to this policy. On February 6, 2026, MSMS sent a formal letter to BCBSM expressing serious concern and requesting an urgent meeting. Then, on February 19, 2026, MSMS joined twenty-six co-signatory organizations in sending a second letter urging BCBSM to rescind the policy before its implementation date.
MSMS’s Key Advocacy Actions
- Submitted detailed data supporting rescindment of the policy
- Raised concerns about patient access and practice sustainability
- Coordinated with specialty societies, physician organizations, and large medical groups
- Worked toward presenting a unified response backed by specialty-specific financial impact data
Although BCBSM has not yet scheduled the requested meeting, it has confirmed that scheduling is in progress. Meanwhile, MSMS presses forward on every available front.
Key Clarifications BCBSM Released
BCBSM published a formal clarification document and FAQ, available through the Availity portal and set for publication in the April 2026 issue of The Record. The clarifications include several important updates.
90-Day Global Period Claims Removed
Claims tied to procedures with a 90-day global surgical period were included in the original policy announcement in error. BCBSM has now removed them from the policy scope. Physicians should use Modifier 57 for E/M services related to a 90-day global procedure. Notably, payment for claims billed with Modifier 57 remains unchanged under this policy.
Revised Policy Exceptions
BCBSM also updated and clarified the list of exceptions. The following services remain excluded from the 50% reduction:
- Preventive E/M services
- Administrative E/M services
- Emergency department E/M codes (99281–99285)
- Claims involving 90-day global surgical periods
These exclusions offer some relief, though they do not address the broader reimbursement concern for the majority of office-based procedures.
What the 50% Cut Means for Practices
For practices that routinely provide medically necessary, separately identifiable E/M services on the same day as minor procedures, this policy creates real financial pressure. Many specialty practices perform these combined services regularly as part of high-quality, efficient patient care. Under the new structure, those practices may see meaningful revenue reductions beginning in mid-2026.
Moreover, bundling the reimbursement reduction into standard office visit billing may discourage physicians from providing same-day care. This threatens both patient access and practice sustainability — two concerns MSMS explicitly raised with BCBSM in its February correspondence.
Which Plans and Patients Are Affected?
The policy applies across several BCBSM-affiliated insurance products. Physicians should review their contracts carefully, as the reduction affects a broad patient base. The plans include:
- 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
