Prospective Relief - Fair Payment Rules


Just what do the Aetna, CIGNA, Health Net, and Anthem/WellPoint settlements in the physicians' national antiracketeering class action lawsuits mean for how physicians do business with these health plans in the future? Here's a side-by-side comparison of the billing, coding, and payment provisions of the four settlements and existing federal law.

Here are the topics the comparison covers:

  • E&M Downcoding
  • Add On and Modifier -51 Exempt
  • Modifier -25
  • Supervision and Interpretation
  • Indented Codes
  • Modifier -59
  • Global Periods
  • Automatic Downcoding of Service Intensity
  • Annual Update of Modifier-51-Exempt Codes
  • Non-exclusive Listing of Modifiers


For even more details, see: