Cigna Medical Policy Updates

October 2017 ~

Cigna has posted updates to specific medical and preventive care services policies, including its uniform billing editor, pharmacy and infusion services, and omnibus reimbursement. These updates, to take effect over the next two months, are as follows:

  • Policy: Omnibus Reimbursement Policy (R24) – Healthcare Common Procedure Coding System (HCPCS) code S9083 is used to bill global urgent care services. Only urgent care facilities should bill using this code. Cigna currently reimburses doctors and other health care providers, including but not limited to nurse practitioners when they bill for services using HCPCS code S9083.
    • Update: Effective October 21, 2017, Cigna will update their Omnibus Reimbursement Policy (R24), and deny claims from providers other than urgent care facilities who bill for services using HCPCS code S9083. Providers should use the appropriate code for the service provided (e.g., evaluation and management)
  • Policy: Pharmacy and Infusion Services (R14) – HCPCS code J7050 is used to bill 250 cc of normal saline. Cigna currently reimburses 250 cc of saline, which is used to flush intravenous lines or as a drug diluent, when billed using HCPCS code J7050.
    • Update: Effective October 21, 2017, Cigna will update their Pharmacy and Infusion Services policy (R14), and deny claims for 250 cc of saline billed with HCPCS code J7050. Saline used to flush intravenous lines or dilute drugs is considered part of the main service, and is not separately reimbursable.
  • Policy: Uniform Billing (UB) Editor – a subset of CMS revenue codes that have corresponding Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes. Cigna currently reimburses claims if they only have the revenue code.
    • Update: Effective November 12, 2017, Cigna will deny claims that do not also include the required CPT® or HCPCS codes in the Field Locator 44 (FL44) field on the UB claim.
CPT® is a registered trademark of the American Medical Association (AMA). All rights reserved.

 

 

Source(s): Cigna Network News;

 

 

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