Before the Division of Health Care Finance and Policy
The Massachusetts Medical Society wishes to be recorded in strong support for proposed amendments to existing regulations governing payment to physicians for services to MassHealth recipients. The adoption of modifiers 25 and 59 and appropriate payment for services billed under such modifiers has long been a goal of the MMS's advocacy efforts. Modifiers 25 and 59 facilitate and reward comprehensive and efficient health care services for patients. Modifier 25 recognizes significant, separately identifiable evaluation and management services provided by the same physician on the same day. Since many MassHealth patients who are covered under fee for service models have complex medical conditions with significant co-morbidities, it has been common for physicians to devote significant time to the evaluation and management of these patients. While for some patients, multiple visits are appropriate, for others with emergency conditions, transportation, mobility or compliance issues, follow up appointments are not the ideal approach. In these cases, physicians providing comprehensive services at one visit have not been compensated for the additional time and work spent in providing care in one visit. The MMS strongly supports the addition of modifier 25 as a recognition of the comprehensive and complex services physicians regularly provide to their patients during a single visit.
The MMS also strongly supports the adoption of modifier 59 to identify a procedure distinct or independent from other services performed on the same day. This modifier will compensate physicians for efficiently treating patients who have presented for one procedure and for whom an additional procedure is medically necessary and appropriate for performance on the same day. As with modifier 25, the adoption of this modifier will greatly improve the care of patients and appropriately compensate physicians engaged in comprehensive treatment procedures.
The MMS notes the addition of modifiers 24 and 57 as well. These modifiers have not been the subject of MMS legislative and regulatory advocacy as with modifiers 25 and 59. However, they cover evaluation and management by the same physician during a post operative period, and decisions for surgery. Both of these services are significant to patients and we appreciate their adoption.
The MMS thanks the Patrick administration for its adoption and implementation of these changes and for the allocation of $1,900,000 to fund their use.
