Airway Clearance Devices
Effective for dates of service on or after March 15, 2021, Cigna will review all claims submitted with HCPCS E0482 (cough stimulating device) to ensure a medically appropriate diagnosis code has been billed. Cigna will deny coverage if the diagnosis is not considered medically necessary. The Airway Clearance Devices in the Ambulatory Setting – (0069) medical coverage policy has been updated to note which diagnosis codes are applicable to HCPCS code E0482.
For information about Cigna's interim billing guidelines and FAQs, click here.
DME, Home Health, and HIT Services
Beginning February 1, 2021, eviCore healthcare (eviCore) will manage durable medical equipment (DME), home health, and home infusion therapy (HIT) services for Cigna commercial customers. Read more about referral and care coordination changes in the quick reference guide
IPN participating providers may still provide the services if they are not participating with eviCore; however, if a provider is participating with both a eviCore and IPN, the eviCore contracted rates will apply. Providers should continue to follow Cigna's preauthorization guidelines when providing services.
Enhanced Specialty Care Options Program for Select Oncology Drugs
As of March 1, 2021, Cigna will expand prior authorization requirements for 16 additional oncology drugs in selected markets to include review of medical necessity of the site of care. For the full list of drugs subject to site of care review, and to review Cigna's policy Medication Administration Site of Care (1605)
, click here
. This policy should be reviewed frequently as it is subject to change without prior notice.
Hiatal Hernia Repair with Bariatric Surgery
Effective for claims with dates of service on or after January 15, 2021, Cigna will begin conducting post-service, prepayment reviews of bariatric surgery claims. Cigna will deny coverage of hiatal hernia repair billed with CPT® code 43281 when performed as part of a bariatric surgery procedure that requires a simple suture repair of a diaphragmatic defect. This change aligns with Cigna's existing medical coverage policy, Bariatric Surgery and Procedures (0051).
Effective for dates of service on or after March 15, 2021, Cigna will deny coverage of physical therapy services billed with CPT codes 97016 (vasopneumatic device) and 97026 (infrared therapy) as not medically necessary.
A vasopneumatic device is used to apply compression to treat extremity swelling and edema. Infrared therapy is a treatment that involves the use of a laser or LED light to treat damaged tissues. Although they may be performed as part of the treatment of musculoskeletal conditions, there is no medical literature to support their clinical effectiveness. They are therefore considered not medically necessary.
Cigna will update the following medical coverage policies as a result of this change:
• Chiropractic Care
• Physical Therapy
• Occupational Therapy
In order to align with Cigna's medical coverage policy: Rhinoplasty, Vestibular Stenosis Repair and Septoplasty (0119), Cigna will begin denying coverage for septoplasty procedures billed with CPT® code 30520 that do not meet medical necessity criteria. This is effective for claims with dates of service on or after March 15, 2021.
Sleep Management Program
Effective February 1, 2021, eviCore healthcare (eviCore) will administer the Cigna Sleep Management Program, replacing CareCentrix (CCx). The program consists of two areas – diagnostic sleep studies and positive airway pressure support therapy – for Cigna commercial customers.
The quick reference guide
contains helpful information, including how to order services, contacts and resources, and precertification requirements.
Medical Policy Updates will be reported in the Q1 2021 issue of Cigna's Network News
. To receive Cigna Network News directly, Sign up at Cignaforhcp.com