The Centers for Medicare & Medicaid Services (CMS) has removed recent modifier -25 guidance from its Medicare Learning Network (MLN) Evaluation and Management (E/M) materials following concerns raised by the American Academy of Ophthalmology (AAO), the American Medical Association (AMA) and the American Society of Retina Specialists (ASRS).

The Academy argued that the guidance differed from established CPT recommendations and could have led to inappropriate audits, overly restrictive interpretations of modifier -25 and barriers to patient access to sight-saving care. Following direct discussions with CMS, the agency removed the examples in question.

This change helps reduce administrative burden for ophthalmology practices and represents an important step toward clearer, more clinically appropriate guidance. Ophthalmologists should continue to maintain thorough documentation supporting E/M services billed with modifier -25 and review any internal compliance policies as needed.

FSO appreciates the advocacy efforts that helped achieve this outcome and will continue to monitor developments affecting ophthalmology practices and patient care.