Cigna Preventive Care Services Policy & Precertification Updates

December 2019 ~

Cigna has made several additions and removals to its precertification list, as well as updates to its Preventive Care Services Policy, including the removal of 69 existing Current Procedure Terminology (CPT^®) codes and Healthcare Common Procedure Coding System (HCPCS) codes and the addition of 70 new codes.

Preventive Care Services Policy Updates

On July 1, 2019, updates became effective for Cigna’s Preventive Care Services Administrative Policy (A004).

Codes: 0064U

Description: Screening for syphilis

Update: Added CPT code

Codes: Z20.1, Z20.2, Z20.5, Z20.6

Description: Wellness codes – Code Group 1

Update: Added ICD-10 codes

Precertification Updates

On October 1, Cigna added 34 CPT^® codes and 36 new HCPCS codes to the precertification list and added 33 existing CPT codes and 15 HCPCS codes that became effective October 25, 2019.

The insurer notes that the gene therapy injectables LUXTURNA^® (HCPCS code J3398) and ZOLGENSMA^®

(HCPCS codes* J3490, J3590, or C9399) were added to the precertification list for all product types, as well as for Cigna’s Personal Health Solutions (PHS) and Cigna Health Matters^® Care Management Basic medical management programs. These injectables already require precertification for Cigna’s PHS+ medical management program, and for the Cigna Health Matters Care Management Basic Standard, Preferred, and Complete medical management programs.

On October 25, Cigna removed 40 existing CPT codes and 29 HCPCS codes from the precertification list. An outline of these monthly precertification updates, as well as the complete list of services that require precertification of coverage, can be found here.

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

Source(s): Cigna Network News October 2019;