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:
Effective for claims with dates of service on or after November 1, 2021:
-
Drug Testing (0513): Cigna will deny claims for drug testing for more than seven classes as not medically necessary. Denials will include medical necessity appeal rights. Updates will be made to the Drug Testing (0513) medical coverage policy to reflect this change.
-
Nucleic Acid Pathogen Testing (0530): Cigna will begin reviewing diagnosis codes to determine medical necessity. Denials will include medical necessity or administrative (incorrect coding) appeal rights. Updates will be made to Nucleic Acid Pathogen Testing (0530) medical coverage policy with a list of affected diagnosis codes.
Effective for claims processed on or after November 1, 2021:
-
Evaluation and Management Services (R30): Cigna will administratively deny evaluation and management (E&M) services as not separately reimbursable when billed with the removal of impacted cerumen when the removal is the sole reason for the visit. This update affects E&M Current Procedural Terminology (CPT®) codes 99202-99205 and 99211-99215 billed with codes 69209 or 69210 for cerumen removal. This update is effective for CMS 1500 claims. Denials will include administrative appeal rights. Updates will be made to the Evaluation and Management Services (R30) reimbursement policy to reflect this change.
-
Code Editing Policy and Guidelines: Cigna will no longer allow modifier overrides where frequency limits are assigned. Denials will be administrative and will include administrative appeal rights. Updates will be made to the Code Editing Policy and Guidelines to reflect this change.
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.
