Bundling
Our Stance
AAFP believes that abiding by the principles of CPT means that payment for covered services should be based on the codes documented and billed by the physician. Health plans should only bundle codes for payment consistent with CPT guidelines. Read the full policy on coding and payment.
Member Wins
- CIGNA Healthcare announced that as of August 2007, they will pay physicians 100% of a preventive service and 50% of an acute service when delivered during the same visit, provided a modifier 25 is appended.
- As of August 2007, UnitedHealthcare will pay physicians for a preventive medicine service plus 50% of an acute E/M service when the E/M service is submitted with modifier 25.
- After AAFP requested a reassessment of their policy, UnitedHealthcare revised its policy on same-day acute and preventive medicine visits in April 2006. Read the letter from UnitedHealthcare (2-page PDF file; About PDFs).
AAFP Advocacy Activities
- Effective August 15, 2009, Aetna began applying concurrency rules when two E/M services are billed and allowed with modifier 25. Aetna considers the preventive medicine visit to be the primary service and payable at 100% of allowed amount and the eligible office, or problem-focused, E/M will be considered the secondary service payable at 50% of allowed amount.
- In November 2005, AAFP sent a letter to 43 health plans advocating for payment of same-day acute and preventive services. Read the letter (4-page PDF file; About PDFs).
Make Your Voice Heard
- Write to your payers to ask them to reimburse for same-day acute and preventive services. Download a template letter (3-page Word document; About Downloading), personalize it and send it to your payers.
- Do you work with a payer that bundles in-office urinalysis as "incidental to" an office visit? Download a template letter (2-page Word document; About Downloading) that advocates for separate payment of urinalysis and E/M services. Personalize this letter and send it to your payers.
- We want to hear about your experiences. Submit a health plan grievance or view grievances submitted by other members (Members Only).
