PACIFICSOURCE COMMUNICATION UPDATES
CIGNA COMMUNICATION UPDATES
Read Cigna's interim billing guidelines and FAQs here.
Effective for claims processed on or after May 16, 2021, Cigna will reimburse laboratory services billed with CPT® codes 83921, 86318, 86332, 86353, and 87798 up to the medically unlikely edit (MUE) limits assigned by the Centers for Medicare & Medicaid Services (CMS). Any units exceeding the MUE limit will be denied. Modifiers will not be allowed to override MUE limits for these codes.
The Frequency Editing (R34)
reimbursement policy will be updated to reflect this change. See more under Reimbursement Policies
Modifier 59 – Distinct Procedural Service
Effective for claims processed on or after May 16, 2021, Cigna will deny reimbursement for debridement services with modifier 59 when billed with a code for an arthroscopic procedure by the same provider, on the same date of service, for the same patient. Arthroscopic debridement is considered incidental to the arthroscopic procedure and is not separately reimbursable. The Modifier 59 – Distinct Procedural Service (M59)
reimbursement policy will be updated to reflect this change. See more under Modifier Policies
myCigna.com - Patient Reviews
Patient reviews began to appear to customers in myCigna.com provider directories beginning January 30, 2020 for the following participating and nonparticipating providers:
• Primary care providers (PCPs)
Due to the success of the initial launch, patient reviews functionality will launch for all U.S. participating and nonparticipating providers (except behavioral health) on February 26, 2021. Beginning on this date, customers will also be able to leave reviews for all providers from the Claims Summary and Claims Detail pages on myCigna.com. In addition, customers will be able to update a past review – both the recommendation and the comments.
Stone Removal During Cystourethroscopy
Effective April 1, 2021, Cigna claim edits will include review of claims billed with both CPT® codes 52352 and 52346 to identify coding accuracy for stone removal during a cystourethroscopy amended with modifiers 59 or XU. Review will be done of operative reports. CPT codes appended with modifier 59 and only one stone removed will be denied. Note: Modifier 59 is used to bill for a distinct procedural service that is independent from other services performed on the same day. Modifier XU is used to bill for an unusual non-overlapping service performed on the same day. More information about the edit will be included in the Q2 2021 issue of Network News.