Cigna Issues 34 New Precertification Codes

September 2018 ~

Cigna has posted the addition of 27 new CPT® codes and seven new HCPCS codes to its precertification list. These new codes, along with six deleted codes, can be seen below.

New CPT Codes & Descriptions

  • 0045U Oncology (breast ductal carcinoma in situ), mRNA, gene expression profiling by real-time RT-PCR of 12 genes (seven content and five housekeeping), utilizing formalin-fixed paraffinembedded tissue, algorithm reported as recurrence score
  • 0046U FLT3 (fms-related tyrosine kinase 3) (e.g., acute myeloid leukemia) internal tandem duplication (ITD) variants, quantitative
  • 0047U Oncology (prostate), mRNA, gene expression profiling by real-time RT-PCR of 17 genes (12 content and five housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a risk score
  • 0048U Oncology (solid organ neoplasia), DNA, targeted sequencing of protein-coding exons of 468 cancer-associated genes, including interrogation for somatic mutations and microsatellite instability, matched with normal specimens, utilizing formalin-fixed paraffin-embedded tumor tissue, report of clinically significant mutation(s)
  • 0049U U NPM1 (nucleophosmin) (e.g., acute myeloid leukemia) gene analysis, quantitative
  • 0050U Targeted genomic sequence analysis panel, acute myelogenous leukemia, DNA analysis, 194 genes, interrogation for sequence variants, copy number variants or rearrangements
  • 0051U Prescription drug monitoring, evaluation of drugs present by LC-MS/MS, urine, 31 drug panel, reported as quantitative results, detected or not detected, per date of service
  • 0052U Lipoprotein, blood, high resolution fractionation and quantitation of lipoproteins, including all five major lipoprotein classes and subclasses of HDL, LDL, and VLDL by vertical auto profile ultracentrifugation
  • 0053U Oncology (prostate cancer), FISH analysis of four genes (ASAP1, HDAC9, CHD1 and PTEN), needle biopsy specimen, algorithm reported as probability of higher tumor grade
  • 0054U Prescription drug monitoring, 14 or more classes of drugs and substances, definitive tandem mass spectrometry with chromatography, capillary blood, quantitative report with therapeutic and toxic ranges, including steady-state range for the prescribed dose when detected, per date of service
  • 0055U Cardiology (heart transplant), cell-free DNA, PCR assay of 96 DNA target sequences
  • (94 single nucleotide polymorphism targets and two control targets), plasma
  • 0056U Hematology (acute myelogenous leukemia), DNA, whole genome next-generation sequencing to detect gene rearrangement(s), blood or bone marrow, report of specific gene rearrangement(s)
  • 0057U Oncology (solid organ neoplasia), mRNA, gene expression profiling by massively parallel sequencing for analysis of 51 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a normalized percentile rank
  • 0058U Oncology (Merkel cell carcinoma), detection of antibodies to the Merkel cell polyoma virus oncoprotein (small T antigen), serum, quantitative
  • 0059U Oncology (Merkel cell carcinoma), detection of antibodies to the Merkel cell polyoma virus capsid protein (VP1), serum, reported as positive or negative
  • 0060U Twin zygosity, genomic targeted sequence analysis of chromosome 2, using circulating cell-free fetal DNA in maternal blood
  • 0061U Transcutaneous measurement of five biomarkers (tissue oxygenation [StO2], oxyhemoglobin [ctHbO2], deoxyhemoglobin [ctHbR], papillary and reticular dermal hemoglobin concentrations [ctHb1 and ctHb2]), using spatial frequency domain imaging (SFDI) and multi-spectral analysis
  • 0505T Endovenous femoral-popliteal arterial revascularization, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural road-mapping and imaging guidance necessary to complete the intervention, all associated radiological supervision and interpretation, when performed, with crossing of the occlusive lesion in an extraluminal fashion
  • 0506T Macular pigment optical density measurement by heterochromatic flicker photometry, unilateral or bilateral, with interpretation and report
  • 0507T Near-infrared dual imaging (i.e., simultaneous reflective and trans-illuminated light) of meibomian glands, unilateral or bilateral, with interpretation and report
  • 0508T Pulse-echo ultrasound bone density measurement resulting in indicator of axial bone mineral density, tibia
  • 22551 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2
  • 22554 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2
  • 22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment
  • 93653 Comprehensive electrophysiologic evaluation, including insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia with right atrial pacing and recording, right ventricular pacing and recording (when necessary), and His bundle recording (when necessary) with intracardiac catheter ablation of arrhythmogenic focus; with treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathway, accessory atrioventricular connection, cavo-tricuspid isthmus or other single atrial focus or source of atrial re-entry
  • 93656 Comprehensive electrophysiologic evaluation, including transseptal catheterizations, insertion and repositioning of multiple electrode catheters with induction or attempted induction of an arrhythmia including left or right atrial pacing/recording when necessary, right ventricular pacing/recording when necessary, and His bundle recording when necessary with intracardiac catheter ablation of atrial fibrillation by pulmonary vein isolation
  • 93657 Additional linear or focal intracardiac catheter ablation of the left or right atrium for treatment of atrial fibrillation remaining after completion of pulmonary vein isolation (list separately in addition to code for primary procedure)

New HCPCS Codes & Descriptions

  • C9030 Injection, copanlisib, 1 mg
  • C9031 Lutetium Lu 177, dotatate, therapeutic, 1 mCi
  • C9032 Injection, voretigene neparvovec-rzyl, 1 billion vector genome
  • Q5105 Retacrit – Injection, epoetin alfa, biosimilar, (Retacrit) (for esrd on dialysis), 100 units
  • Q5106 Retacrit – Injection, epoetin alfa, biosimilar, (Retacrit) (for non-esrd use), 1000 units
  • Q9993 Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg
  • Q9995 Injection, emicizumab-kxwh, 0.5 mg

Codes Removed from the Precertification List on July 1, 2018

On July 1, Cigna removed six HCPCS codes from its precertification list.

HCPCS Codes & Descriptions

  • G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77067)
  • J1439 Injection, ferric carboxymaltose, 1mg
  • J1446 Granix – Injection, TBO-filgrastim, (Granix), 5 micrograms
  • J1447 Injection, tbo-filgrastim, 1 microgram
  • J2547 Injection, peramivir, 1 mg
  • J3110 Injection, Teriparatide, 10 mcg

For more information and to view an online list of monthly precertification updates, as well as the complete list of services that require precertification of coverage, log in to the Cigna for Health Care Professionals website and click Precertification Policies under Useful Links.

 

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

 

 

Source(s): Cigna Network News July 2018;

 

 

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