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Coding Corner: How and when to append modifier 25

June 17, 2024
Area(s) of Interest: Out of Network Billing Cyber Security 


Citing the impact the Change Healthcare cyberattack has had on health care operations across the country, the Centers for Medicare and Medicaid Services (CMS) last week announced it would extend filing deadlines for out of network payment disputes under the federal No Surprises Act (NSA).

While providers usually have 30 days after a payment is made to initiate the open negotiation process, the first step in the NSA’s independent dispute resolution (IDR) process, this extension will allow them to initiate the open negotiation at any point during the 120-day exception period, beginning June 14, 2024, and ending October 12, 2024.

To invoke the exception, physicians will need to fill out an attestation form to indicate that their ability to initiate the dispute was impacted by the cyberattack and submit that form alongside the standard open negotiation initiation form. Parties seeking to invoke the exception do not also need to request extensions via the federal IDR Inbox.

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