PACIFICSOURCE COMMUNICATION UPDATES
CIGNA COMMUNICATION UPDATES
Read Cigna's interim billing guidelines and FAQs here.
Modifier 26 – Professional Component
Effective July 10, 2021, Cigna will deny CPT® codes billed with modifier 26 when applied inappropriately based on the CMS National Physician Fee Schedule. According to CMS payment policies, there are identified CPT and Healthcare Common Procedure Coding System (HCPCS) codes where modifier 26 is not applicable. This update aligns with Cigna's current reimbursement policy, Modifier 26 –Professional Component (M26) and will be applicable to all claims processed on or after becoming effective.
Therapeutic Continuous Glucose Monitors
Effective July 1, 2021, Cigna coverage for therapeutic continuous glucose monitors (CGMs) will change for customers with both Cigna medical and pharmacy coverage. Cigna will cover all components of therapeutic CGMs under the pharmacy benefit and no longer cover therapeutic CGMs filled through a durable medical equipment (DME) or medical supply vendor under the medical benefit. There is no change for nontherapeutic CGMs.
Providers are advised to send prescriptions for their patients with Cigna medical and pharmacy coverage, who also use a therapeutic CGM, to a participating retail pharmacy or to Express Scripts® Pharmacy, before medical orders expire on July 1. Additionally, beginning July 1, 2021, DME and medical supply vendors must request precertification for any therapeutic CGM orders they receive for Cigna customers.