CIGNA COMMUNICATION UPDATES
COVID-19
Read Cigna's interim billing guidelines and FAQs
here.
Policy & Reimbursement Updates
Cigna routinely reviews coverage, reimbursement, and administrative policies for potential updates. In that review, Cigna takes into consideration one or more of the following: Evidence-based medicine (EBM), professional society recommendations, Centers for Medicare & Medicaid Services (CMS) guidance, industry standards, and our other existing policies. Below are policies that will be changing:
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Add-on codes billed without a base code: Cigna will review outpatient facility (UB-04) claims and deny charges for add-on codes billed without a base code or when the base code is denied. Add-on codes are eligible for payment only when reported with the appropriate primary procedure performed by the same facility, on the same date of service, for the same customer. Administrative appeal rights will be available. This update is effective for claims processed on or after December 1, 2021. Cigna update the Code Editing Policy and Guidelines to reflect this change
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Emergency Room Services (R36): Cigna will review facility (UB-04) claims submitted with emergency room (ER) evaluation and management (E&M) Current Procedural Terminology (CPT®) codes 99284 and 99285 for billing and coding accuracy. Claims may be adjusted and reimbursed at one CPT code level lower. This update is effective for claims processed on or after January 1, 2022, and applies if the customer was discharged from the ER. Administrative appeal rights are available. Cigna's reimbursement policy to reflect this change.
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Modifier 26 – Professional Component (M26): Cigna will deny separate reimbursement for CPT® codes billed modifier 26 for the professional component of a service or procedure when the CMS National Physician Fee Schedule does not recognize the existence of a professional component for a particular code. This update aligns with the current reimbursement policy, and the CMS National Physician Fee Schedule. The effective date is based on the claims processing date, and varies by state-regulated notice requirements: Idaho and Oregon: October 27 and Washington: November 26. For all other states: Refer to Cigna policy
For more information about reimbursement policies, log in to the Cigna for Health Care Professionals website (CignaforHCP.com) > Resources > Reimbursement and Payment Policies > Reimbursement and Modifier Policies > Reimbursement Policies.
Precertification Program
Effective January 1, 2022, precertification for the gastroenterology procedures listed below will be required for most Cigna commercial (non-Medicare) customers:
- Esophagoscopy/esophagogastroduodenoscopy
- Most capsule endoscopies
Cigna's goal is to ensure that tests and procedures are medically necessary according to evidence-based guidelines. Cigna has delegated precertification for these procedures to eviCore healthcare.
