Cigna Clinical, Reimbursement, and Administrative Policy Updates

February 2020 ~

Cigna has released its latest clinical, reimbursement, and administrative policy updates, which includes policy updates for certain anesthesia services, care integration services, and (Evaluation and Management) E & M services.

These updates are as follows.

Policy: Incontinence supplies

Effective Date: January 1, 2020 for claims processed on or after this date.

Update: To ensure consistent claims processing, Cigna will deny charges for all incontinence supplies when billed with Healthcare Common Procedure Coding System (HCPCS) codes that begin with “T” or “A” as not reimbursable. Incontinence supplies are used to meet daily needs and are not considered a covered medical benefit. Note: No coverage or reimbursement policies are affected by this change.

Policy: Allergy Testing and Non-Pharmacologic Treatment (0070)

Effective Date: February 17, 2020 for dates of service beginning on this date

Update: Cigna will limit coverage for allergy testing in a 12-month rolling period for claims billed with certain Current Procedural Terminology (CPT^®) codes. The affected CPT codes are 86003 – 80 units, 95004 – 80 units, and 95024 – 40 units. The current medical coverage policy, Allergy Testing and Non-Pharmacologic Treatment (0070), will be updated to reflect this change. Note: Only the line item for the CPT codes listed above will be affected.

Policy: Anesthesia Services for Interventional Pain Management Procedures in an Adult (0551)

Effective Date: February 17, 2020 for dates of service beginning on this date.

Update: Cigna will implement a new medical coverage policy, Anesthesia Services for Interventional Pain Management Procedures in an Adult (0551), to only allow sedation coverage for certain diagnoses specified in the policy, for interventional pain management services. Note: This policy only applies to customers age 18 and older

Policy: Care Integration Services (R32)

Effective Date: February 17, 2020 for dates of service beginning on this date.

Update: Cigna will implement a new reimbursement policy, Care Integration Services (R32), to deny codes for care integration as included in the reimbursement for the overall care of the customer.

Policy: Evaluation and Management Services (R30)

Effective Date: March 16, 2020 for claims processed on or after this date.

Update: Cigna will update the Evaluation and Management Services (R30) reimbursement policy, and require documentation to review the appropriate use of billing for E&M services when billed with codes for a joint injection or aspiration. Reimbursement for the E&M codes may be denied.

Policy: Evaluation and Management Services (R30)

Effective Date: March 16, 2020 for claims processed on or after this date.

Update: Cigna will update the Evaluation and Management Services (R30) reimbursement policy, and deny reimbursement for E&M services billed with CPT code 99211 appended with modifier 25 when billed alone or with another procedure code on the same date of service. Only the line item for CPT code 99211 appended with modifier 25 will be denied. Services billed with other codes on the same claim will be reimbursed according to the terms of the insurer’s policies and the provider’s agreement.

CPT^® is a registered trademark of the American Medical Association.

Source(s): Cigna Network News, First Quarter 2020;