Cigna Clinical, Reimbursement, Admin and Preventive Care Updates

November 2018 ~

Cigna has published a number of clinical, reimbursement, and administrative policy updates, including its reimbursement policy for Infusion and Injection Administration Services with Emergency Department as Place of Service and precertification changes for Cardiac Electrophysiological Studies.

Clinical, Reimbursement, and Administrative Policy Updates

Precertification Updates

On October 1, Cigna added three HCPCS codes and 20 CPT^® codes.

33224 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or implantable defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator)

33225 Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (e.g., for upgrade to dual chamber system) (List separately in addition to code for primary procedure)

0062U Autoimmune (systemic lupus erythematosus), IgG and IgM analysis of 80 biomarkers, utilizing serum, algorithm reported with a risk score

0063U Neurology (autism), 32 amines by LC-MS/MS, using plasma, algorithm reported as metabolic signature associated with autism spectrum disorder

0064U Antibody, Treponema pallidum, total and rapid plasma reagin (RPR), immunoassay, qualitative 0065U Syphilis test, non-treponemal antibody, immunoassay, qualitative (RPR)

0066U Placental alpha-micro globulin-1 (PAMG-1), immunoassay with direct optical observation, cervico-vaginal fluid, each specimen

0067U Oncology (breast), immunohistochemistry, protein expression profiling of four biomarkers (matrix metalloproteinase-1 [MMP-1], carcinoembryonic antigen-related cell adhesion molecule 6 [CEACAM6], hyaluronoglucosaminidase [HYAL1], highly expressed in cancer protein [HEC1]), formalin-fixed paraffin-embedded precancerous breast tissue, algorithm reported as carcinoma risk score

0068U Candida species panel (C. albicans, C. glabrata, C. parapsilosis, C. kruseii, C tropicalis, and C. auris), amplified probe technique with qualitative report of the presence or absence of each species

0069U Oncology (colorectal), microRNA, RT-PCR expression profiling of miR-31-3p, formalin fixed paraffin-embedded tissue, algorithm reported as an expression score

0070U CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism) gene analysis, common and select rare variants (i.e., *2, *3, *4, *4N, *5, *6, *7, *8, *9, *10, *11, *12, *13, *14A, *14B, *15, *17, *29, *35, *36, *41, *57, *61, *63, *68, *83, *xN)

0071U CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism) gene analysis, full gene sequence (List separately in addition to code for primary procedure)

0072U CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism) gene analysis, targeted sequence analysis (i.e., CYP2D6-2D7 hybrid gene) (List separately in addition to code for primary procedure)

0073U CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism) gene analysis, targeted sequence analysis (i.e., CYP2D7-2D6 hybrid gene) (List separately in addition to code for primary procedure)

0074U CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism) gene analysis, targeted sequence analysis (i.e., non-duplicated gene when duplication/ multiplication is trans) (List separately in addition to code for primary procedure)

0075U CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism) gene analysis, targeted sequence analysis (i.e., 5’ gene duplication/multiplication) (List separately in addition to code for primary procedure)

0076U CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism) gene analysis, targeted sequence analysis (i.e., 3’ gene duplication/ multiplication) (List separately in addition to code for primary procedure)

0077U Immunoglobulin paraprotein (M-protein), qualitative, immunoprecipitation and mass spectrometry, blood or urine, including isotype

0078U Pain management (opioid-use disorder) genotyping panel, 16 common variants (i.e., ABCB1, COMT, DAT1, DBH, DOR, DRD1, DRD2, DRD4, GABA, GAL, HTR2A, HTTLPR, MTHFR, MUOR, OPRK1, OPRM1), buccal swab or other germline tissue sample, algorithm reported as positive or negative risk of opioid-use disorder

0079U Comparative DNA analysis using multiple selected single-nucleotide polymorphisms (SNPs), urine and buccal DNA, for specimen identity verification

C9033^* Injection, fosnetupitant 235 mg and palonosetron 0.25 mg

C9750 Insertion or removal and replacement of intracardiac ischemia monitoring system including imaging supervision and interpretation and perioperative interrogation and programming; complete system (includes device and electrode)

Q5110^* Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram

* HCPCS codes C9033 and Q5110 will be managed through Cigna’s Integrated Oncology Management Program managed by eviCore Healthcare

For a complete listing of Cigna’s existing policies, including the policies above, as well as an outline of monthly coverage policy changes and a full listing of medical coverage policies, visit Cigna’s Policy Updates page.

And for a list of monthly precertification updates, as well as the complete list of services that require precertification of coverage, Cigna’s Precertification Policies.

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

Source(s): Cigna Network News October 2018;