Cigna Reference Guide
Click here to read the revised Cigna Reference Guide for participating physicians, hospitals, ancillaries, and other health care professionals.
Reimbursement Policy Update
Cigna routinely reviews coverage, reimbursement, and administrative policies for potential updates. In that review, consideration is taken of one or more of the following: Evidence-based medicine, professional society recommendations, Centers for Medicare & Medicaid Services guidance, industry standards, and other existing policies.
As a result of a recent review, Cigna will reduce reimbursement to $5 for Current Procedural Terminology (CPT®) codes billed with modifier 26 when the professional component/technical component (PC/TC) payment indicator is 3 or 9. This update is effective for claims processed on or after July 1, 2022. This change aligns with the current reimbursement policy, Modifier 26 Professional Component, and the CMS National Physician Fee Schedule.
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.
SPRAVATO Coverage Change
Effective July 1*, Cigna will change how it covers SPRAVATO®. Cigna will cover SPRAVATO under the pharmacy benefit but will no longer cover the drug under the medical benefit. SPRAVATO (esketamine) is a nasal spray for treatment-resistant depression in adults who have not benefited from other treatments and major depressive disorder with acute suicidal ideation or behavior. For customers who do not have Cigna pharmacy benefits, the pharmacy plan administrator will determine coverage.
Please note: This change should not affect most behavioral health providers since Evernorth Behavioral Health has always advised that they should leverage a customer’s pharmacy benefits for SPRAVATO.
