Cigna procedure codes. 8 Pediatric Head Imaging Age Considerations (PEDHD-1.

Cigna procedure codes What you need to know Prenatal care looks for the percent of patients who delivered and had prenatal care visits procedure code(s) outlined in the Coding Information section of this policy. These two companies use a unique CPT code for EAP sessions. Cigna Medical Coverage Policy - Therapy Services . Extraoral - 2D Projection . Our surgical procedures policies offer guidelines for health care providers submitting claims for this coverage policy may not apply to all benefit plans administered by Cigna. Skin cancer may be treated more successfully if it is caught early. Reimbursement is not allowed for services when billed for Cigna Healthcare monitors claims by conducting claims audits and by reference to medical records. Administrative Policies are intended to provide further information about the administration of . Effective Date: 4/15/2024 . CPT code billed: 99202 Modifier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Contracted Fee (CF): The most Cigna will pay a dentist for a covered service or procedure for out-of-network dental care that is based on a basic Cigna DPPO Advantage fee schedule within a specified area. + Use the Procedure Code Benefit Tool on Provider. Claims submitted Overview. Certain Cigna Companies and/or lines of business only provide utilization review services to clients 1,25(OH)2D (CPT® code 82652) Serum 1,25(OH)2D is not suitable to assess Vitamin D status because it is kept within reference in the applicable Coverage Policy, including covered diagnosis and/or procedure code(s). ). However, 19350 would be covered if requested along with 19303 as per the federal mandate. , Kinesio taping) or rigid therapeutic taping (i. Cigna CPT code list for the current list of gastrointestinal procedures %PDF-1. TMJ X-Ray - other . cignaforhcp. Next Review Date: 12/15/2025 . Next Review Date: 4/15/2025 . The procedure code benefit lookup results do not represent a guarantee of coverage or that the Will I be able to look up procedure codes for all my Cigna patients ? You will be able to look up codes for patients whose claims are processed paid by Cigna and have PPO or OAP Modifier - Bilateral Procedures - (M50) PDF: 190kB: 07/14/2024: Modifier - Distinct Procedural Service - (M59) PDF: 109kB: 05/16/2021: Modifier - Distinct Procedural Service Code List - CPT Category III codes are a set of temporary (T) codes assigned to emerging technologies, services, and procedures. Place of service, service type, and other identifying information about the service(s). Procedure (HCPCS) Codes (CMM-312) References (CMM-312) The following Coverage Policy applies to health benefit plans administered by Cigna Companies. for Vitamin D Testing. 00 D0330 X-rays (panoramic radiographic image) (limit 1 every 3 years) – (D0330 or D0701) within 3 years $0. Instructions for use . section for ANY of the following: • diagnostic nasal/sinus endoscopy: CPT® Code Code Description 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) Cigna enta Care Pan PA C C 4 Code Procedure description Procedure charge Diagnostic/preventive (continued) D0274 X-rays (bitewings) – 4 radiographic images $0. com to access your patient’s benefit information online. See example provided diagnosis and/or procedure code(s). com and click on ‘Resources > Claim Editing Procedures’. Certain Cigna Companies and/or lines of business only provide utilization review services to clients (CPT code 81291) or apolipoprotein E (APOE) (HCPCS code S3852). Cigna benefit plans. Acupuncture . A device called a transducer sends sound waves that echo off your heart and back to the transducer. D0250. , non-vascular lesion) using laser therapy (e. Next Review Date: 4/15/202 5 . 0). Here you will find links to several key resources for health care professionals to help your practice perform efficiently and make it easier to do business with Cigna. These guidelines include procedures eviCore does not review for Cigna. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. Elastic therapeutic taping (i. 475: Procedure code not valid for patient age. Reimbursement is not allowed for services when billed for Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. CPT codes need to be used for the services provided. 05/30/2011 Policy template updated 08/06/2009 Policy effective with CIGNA Great-West business • Learn how Cigna Healthcare is supporting our customers and health care providers impacted by the wildfires in California. m. CMS 1500 Drug tests(s), presumptive, by direct optical observation 300 80305 No CMS 1500 UB only if OP procedures. Page 2 of 17 Medical Coverage Policy: 0159 . Low-Level Laser and High -Power Laser Therapy . Please note that our interim COVID-19 virtual care guidelines were in place until December 31, 2020. Pre-authorisation number (please state “no pre-authorisation” if treatment was not pre-authorised) 3. 4 General Guidelines (PEDHD-1. Certain Cigna Companies and/or lines of business only provide utilization review services to clients (CPT® Code 17110, 17111, 0479T, 0480T) includes up to six treatments. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). ProcedureCodes. When billing, providers . Cigna created this procedure code to describe EAP sessions taking place through their billing system. under this Coverage Policy (see “Coding Information” below). D0321 . Page 2 of 35 Medical Coverage Policy: 0505 . We operate a policy of zero tolerance of fraud and misrepresentation and will cease to deal with any provider who provides false, misleading or selective information. Click Add Service(s) if you wish to add additional procedure codes. D0320 . this coverage policy mya not apply to all benefit plans administered by Cigna. Reimbursement is not allowed for services when billed for conditions or diagnoses that are not covered under this Coverage Policy (see “Coding Information” below). e. Reimbursement is not allowed for services when billed for conditions or diagnoses that are not covered under this policy. Cigna covers a custom-fabricated AFO or KAFO (HCPCS code L1900, L1904, L1907, L1920, L1940– L1950, L1960–L1970, L1980–L2034, L2036–L2108 and L2126–L2128, L4631) in an AMBULATORY individual who meets the above medical necessity criteria for an AFO or KAFO and ANY ONE of the The Cigna Cost of Care Estimator You should then enter in CPT or HCPCS codes, place of service, service type, other identifying information about the service(s), and anticipated date of service, along with identifying information about your patient (date of birth, Cigna ID number, etc. March 15, 2025, for dates of service on or after this date. 96101 – Psychological testing, interpretation and reporting by a psychologist (per Hour) 90880 – Hypnotherapy – limit 10 units/hours per application; 90876 – Biofeedback; CPT Code(s) * + Add ? Add multiple codes by using the Tab or Enter keys or by clicking the “+ Add” button. A4287 new code collection bag breast milk G0011, G0013- counseling for PReP The following Coverage Policy applies to health benefit plans administered by Cigna Companies. We will add 10 codes with a status B indicator: CPT codes 38204, 92921, 92925, 92929, 92934, 92938, 92944, and 97602, and Healthcare Common Procedure Coding System (HCPCS) codes A4262 and A4263. Benign Prostatic Hyperplasia (BPH) Surgical Treatments CPT Codes 82306 and 0038U and a separate and distinct set for ICD10 Code 82652. 92249. Please refer to verification of benefits at verifyallegiance. org, and select CPT. D0310. 2024 MRI/MRA CPT ® MRI Cervical without contrast 72141 • Added CPT codes C9784 and C9785 to the EIU coverage statement for the correct procedures they represent. TMJ Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. INSTRUCTIONS FOR USE . com for plan information before proceeding with any Use this quick reference guide for tips and up-to-date procedure codes that will help you maintain and even improve your HEDIS scores. com. D0310 . CPT Procedure Codes Associated with Head Imaging. 0. Preventive Services Task Force (USPSTF) hasn't recommended for or against routine skin cancer screening for adults at normal risk. If you choose to see a provider not in the Cigna Dental Allowance (DPPO) network, and have the Full Allowance or the 50% out-of- Procedure Code Procedure code description. o Mandible (jaw): CT Maxillofacial (CPT® 70486, CPT® 70487, or CPT® 70488) or The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Page 2 of 26 Medical Coverage Policy: 0099 . Adding CPT II codes on claims for information in this coverage policy may not apply to all benefit plans administered by Cigna. regarding treatment of hypertrophic scar (i. Cigna is a member of The Clinical Coding and Schedule Development (CCSD) group. Certain Cigna Companies and/or lines of business only provide utilization review services to clients (CPT Codes 95940, 95941; HCPCS Code G0453) Continuous intraoperative neurophysiologic monitoring (IOM) is considered medically this coverage policy may not apply to all benefit plans administered by Cigna. Whether the care is delivered as an in-patient, day-patient, or out-patient, or in a consulting room, nursing home or the patient’s home 5. including covered diagnosis and/or procedure code(s). 1 The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Cigna Medical Coverage Policies – Musculoskeletal Epidural Steroid Injections Effective August 1, 2024. Coverage Policy, including covered diagnosis and/or procedure code(s). Page 2 of 31 Medical Coverage Policy: 0518 ; RETIRED ; Valid for dates of service prior to 11/1/24 only Coverage Policy, including covered diagnosis and/or procedure code(s). If you know it, enter the CPT or HCPCS procedure code. How to access Cigna Healthcare coverage policies. In the event of a conflict, a customer’s benefit plan document . , McConnell) is considered Cigna Medical Coverage Policies – Gastrointestinal Endoscopic Procedure . • Changed the EIU statement for bariatric surgery for primary treatment of any condition other than morbid obesity to NMN because it doesn’t meet Cigna’s definition of EIU. Find an in-network doctor, dentist, or facility Find a form Find 1095-B tax form information View the Cigna Glossary Contact Cigna Audiences These guidelines include procedures eviCore does not review for Cigna. Certain Cigna Companies and/or lines of business only provide utilization review services to clients including covered diagnosis and/or procedure code(s). local time, 7 days a week. When billing, providers must use the most apolicy ppropriate codes as procedure code(s) outlined in the Coding Information section of this policy. must use the most appropriate codes as of the effective date of the submission. All Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group. When billing, providers must use the most appropriate codes as Relevant CPT Codes: CPT 97161, 97162, and 97163 – Physical Therapy evaluation, CPT 97165, 97166, and 97167 – Occupational Therapy evaluation, and CPT 97169, 97170, and 97171 - Athletic Training evaluation . When billing, providers Cigna Medical Coverage Policy - Therapy Services . Codes added to the precertification list in January 2024. You can also refer to the Preventive Care Services – (A004) Administrative Policy [PDF] for detailed information on our coverage policy for preventive CPT® Code CPT® Code Description: Medicare Prior Authorization Required? Medicare Case Build Platform: Commercial Prior Authorization Required? this HCPCS code please reach out to Cigna at 888-454-0013 option 5 or (fax) 877-730-3858: Yes CareCore National: Out Of Scope eP360: For this HCPCS code Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. ) The following Coverage Policy applies to health benefit plans administered by Cigna Companies. The most up to date and comprehensive information about our standard coverage policies are available on CignaforHCP, without logging in, for your convenience. Reimbursement is not allowed for services when billed for Rev codes Preferred CPT/HCPCS codes Authorization Required Billing Form Applied Behavioral Analysis (ABA) N/A 0362T, 0373T, 97151 - 97158 Call to verify. For a full list of CPT Category II codes, visit . Authorization requirement is dependent upon benefit plan. CPT Procedure Codes Associated with Musculoskeletal Imaging 3 General Guidelines (MS -1) 4 Imaging Techniques (MS -2) 6 • Shoulder (CPT code 29240) • Chest or thorax (CPT code 29200) • Hip (CPT code 29520) • Elbow or wrist (CPT code 29260) • Knee (CPT code 29530) • Back (CPT code: 29799) Experimental, Investigational, Unproven . Certain Cigna Companies and/or lines of business only provide utilization review services to clients Remote Physiologic Monitoring (RPM) (CPT® codes 99091, 99453, 99454, 99457, 99458, HCPCS code G0322) is considered medically necessary for ANY of Category III Current Procedural Terminology (CPT®) codes . Extraoral - 2D Projection. Evernorth. Next Review Date: 11/15/2025 . Sialography X-Ray . Device) (HCPCS Code E2120). Next Review Date: 3/15/2025 . CIGNA specifically identified two edit types with two modifiers (CMS/NCCI Incidental edits with modifier 25 and CMS The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Procedure Code Procedure code description D0250 . PDL will submit to Cigna only the diagnosis (codes) provided to PDL by the ordering provider and/or his/her authorized staff. The U. PCOMM-2024-1118. Therefore, please refer to those guidelines for services rendered prior to January 1, 2021. Enter a procedure code. Posting January 2, 2024. Please refer to the Cigna CPT code list for the current list of hiechgh-t imaging procedures tiCore reviewshat ev for Cigna. Please note that our fee schedule search facility does not currently highlight any ineligible combinations of codes. Surgical Maze or modified Maze procedure including endoscopic Maze as a part of a hybrid convergent procedure without cardiopulmonary bypass when concomitant cardiac surgery is not performed (CPT® codes 33254, 33255, 33265, 33266) is considered experimental, investigational or unproven for any indication including the These guidelines include procedures eviCore does not review for Cigna. Cigna Medical Coverage Policies – Musculoskeletal Knee Surgery: Arthroscopic and Open Procedures Effective August 1, 2024 _____ Instructions for use . Apr 01, 2015 The following Coverage Policy applies to health benefit plans administered by Cigna Companies. 8 Pediatric Head Imaging Age Considerations (PEDHD-1. Certain Cigna Companies and/or lines of business only provide utilization review services to clients Refer to the table in Appendix A for a list of products and the associated CPT and HCPCS codes. g. Cigna Medical Coverage Policy- Therapy Services . CPT Code 99404 Description. Reimbursement is not allowed for services when billed for conditions or diagnoses that are not covered under this policy . CPT Category II codes are not a replacement for CPT codes. In some cases, the office visit is not separately reimbursable from the surgical code; the office visit copay does not apply. Coverage Bilaterial Procedures (M50) We will reimburse bilateral procedure codes billed with modifier 50 at 150 percent of the fee schedule or other allowed amount. On January 1, 2024, we added 25 new Current Procedural Terminology (CPT ®) codes and 24 new Healthcare Common Procedure Coding System (HCPCS) codes. The following coverage policy applies to health benefit plans administered by Cigna. Acupuncture treatment can vary from Acupuncture alone (CPT codes 97810, 97811, 97813, 97814) to the use of a variety of modalities and procedures depending on the patient’s condition, response Cigna Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benet plans. 7 %âãÏÓ 2347 0 obj >stream hÞÄ{íŽãF²e½€ `ÿq l7 © ¿IÏÅ ÚîñØ×ö¸ÑíÅa J¢ªè¦H IUµü ~âÝ='2“LRR}´}×cLWJÊŒŒˆŒŒ8 éF Code Description with Cigna Reimbursement Policy and Coverage Position Examples include, but are not limited to: 100. Up to three Current Procedural Terminology (CPT ®) codes, Healthcare Common Procedure Coding System (HCPCS) codes, or Diagnosis Related Group (DRG) codes. CPT Procedure Codes Associated with Musculoskeletal Imaging 3 General Guidelines (MS-1) 4 Imaging Techniques (MS-2) 6 in the applicable Coverage Policy, including covered diagnosis and/or procedure code(s). In a transthoracic echocardiogram These guidelines include procedures eviCore does not review for Cigna. Physical Performance Test or Measurement. If you don’t know the procedure code, you can search for one. A dentist who incorrectly describes on a third approved code, first published in party claim form a dental procedure in order to receive a greater CDT 2017 and effective Jan 1, 2017 payment or reimbursement or incorrectly makes a non turbinectomy (see CPT® code lists below) are considered medically necessary when the associated signs and symptoms or diagnoses are listed in the Coding Information . Click Search to find a procedure code. These codes are intended to be used for data collection to substantiate more widespread usage or to provide documentation for the Food and Drug Administration (FDA) approval process. Routine service or supply, not separately billable – • inclusive in procedure or room and board : Cigna Reimbursement Policy R12: Admission kit • Sutures, staples, clips, and sealants (internal and external) Preventive care services are reported with diagnosis and procedure codes which identify the services as preventive and not for treatment of injury or illness. Coverage policies are Procedure (CPT ®) Codes (CMM-200) References (CMM-200) The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Update Important changes in coverage criteria. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance obtain benefit detail at the procedure code level. No change to conditions covered or Cigna covers trigger-point injection(s) of anesthetic and/or corticosteroid (CPT codes 20552, 20553) for diagnosis/stabilization of subacute or chronic back, or neck pain, or subacute or chronic myofascial Cigna covers SI joint injection (CPT code 27096, HCPCS code G0260) for the treatment of back pain associated with localized SI joint Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. the information in an Administrative Policy. Title: Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and in the applicable Coverage Policy, including covered diagnosis and/or this coverage policy may not apply to all benefit plans administered by Cigna. CPT Procedure Codes associated with Musculoskeletal . When billing, providers this coverage policy may not apply to all benefit plans administered by Cigna. When billing, providers must use the most appropriate this coverage policy may not apply to all benefit plans administered by Cigna. Effective April 1, 2024. Upon submission of a precertification request, please provide all required information. Cigna Dental Allowance (DPPO) providers will bill Cigna Healthcare directly on your behalf. Reimbursement is not allowed for services when billed for conditions or diagnoses that are not covered under this Coverage Policy (see Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and in the applicable Coverage Policy, including covered diagnosis and/or procedure code(s). Failure to provide all necessary information required for the review may result in the denial of certification for an admission, procedure or Cigna does not provide additional reimbursement based upon the type of instruments, technique or approach 04/01/2013 Updated with ICD-9 Procedure Codes and new template. coding guidelines, including those related to an unacceptable primary and principal The Cigna Dental Allowance benefit covers routine preventive and comprehensive dental services, which are not covered by Medicare. Effective Date: 11/15/2024 . Select a . Age or frequency limits are utilized Cigna does not process preventive care claims solely based on the presence of modifier 33, which was with a designated wellness or maternity diagnosis code in the primary position on the claim form. Note: ALL ICD-10, CPT® and HCPCS codes billed for a preventive service should follow standard . 00 D2740 Crown – Porcelain/ceramic substrate $520. If a procedure code narrative does not specify whether it is an open or an Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. These echoes are turned into moving pictures of your heart that can be seen on a video screen. . The following Coverage Policy applies to health benefit plans administered by Cigna Companies. 2024 General Guidelines (MS-1. Reimbursement is not allowed for services when billed for conditions or diagnoses that are not covered under this . 2. • The Cigna Group announced an agreement to divest our Medicare Advantage, Cigna Supplemental Benefits (which includes Medicare Supplemental Benefits), Medicare Part D, and CareAllies businesses to Health Care Service Corporation (HCSC). procedure code(s) outlined in the Coding Information section of this policy. When billing, providers must use the most appropriate codes as of the effective date of the submission. CPT Category II codes are supplemental tracking codes that can be used for performance measurement. When billing, providers must use the most As of February 1, 2021, eviCore healthcare (eviCore) will administer the Cigna Sleep Management Program, which consists of two areas – diagnostic sleep studies and positive airway pressure (PAP) therapy support for Cigna commercial customers diagnosed with sleep apnea. Claims submitted Participating providers cannot balance bill customers for charges in excess of Cigna Healthcare SM allowable amounts. 00 D0277 X-rays (bitewings, vertical) – 7 to 8 radiographic images $0. Procedure code from the CIGNA Schedule of Procedures 2. The evaluation codes reflect 3 levels of patient presentation: low -complexity, moderate-complexity, and high-complexity. To standard Current Procedural Terminology (CPT ®) code sets and modifiers; standard International Classification of Diseases (ICD-10) codes, tenth revision Cigna Healthcare is committed to providing solutions that can minimize your administrative costs while helping to reduce the complexity of doing business with us. Code Procedure description Procedure charge Office Visit Fee (Per Patient, Per Office Visit, in addition to any applicable patient charges) CPT Code 99404 is an oddity in the collection of regularly billed CPT codes. standard . Reimbursement is not The following Coverage Policy applies to health benefit plans administered by Cigna Companies. footnote 1 This means the USPSTF didn't find enough evidence from studies to show that all adults with a normal risk for skin cancer would benefit from having After-hours services represented by CPT codes 99051 – 99056 and 99060 do not support physicians’ treating patients in the website at www. Capsule Endoscopy . Please refer to the . Musculoskeletal Imaging Guidelines V1. Disclaimer: By checking this box you understand that benefit limits or review recommendations may apply to these services. Patient information (date of birth, Cigna Healthcare ID number, etc. When billing, providers must use the most appropriate codes as • Remove CPT code C1783 and L8612 from XEN • Replaced with new cobranded Cigna-EviCore guidelines CMM-609 Lumbar Fusion (Arthrodesis), CMM-611 Sacroiliac Joint Fusion or Stabilization, and CMM-614 Thoracic and Thoracolumbar Fusion this coverage policy may not apply to all benefit plans administered by Cigna. a - 2 - CIGNA DENTAL CARE PATIENT CHARGE SCHEDULE (G1-09) Important Highlights (Continued) Patient Charge Code Procedure Description Code Procedure Description D2544 Onlay – Metallic – 4 or more surfaces $505. Axial/Spinal Decompression Therapy/Mechanical Traction (Provided in a Clinic Setting) Effective Date: 4/15/2024 . When billing, providers Cigna Medical Coverage Policy- Therapy Services . Preventive Care Services in the applicable Coverage Policy, including covered diagnosis and/or procedure code(s). Certain Cigna Companies and/or lines of business only provide utilization review services to clients CPT codes: 87797, 87798, 87799, for molecular microbe testing is not covered or reimbursable when a more specific CPT/HCPCS code is available for Doctors often do not know how much a procedure or course of treatment will cost, but they can usually direct you to the people who have the information, such as: A staff person in their office. The CCSD schedule contains Search the Cigna UK Fee Schedule by entering a code or keyword. Fee for each in the applicable Coverage Policy, including covered diagnosis and/or procedure code(s). PDL does not – through this Reference Guide or otherwise – recommend any particular diagnosis codes. To find the most recent Medical Necessity Review list, precertification policies, and modifiers and reimbursement policies, log in to CignaforHCP. These fees are effective from . C v2. Use Current Procedural Terminology (CPT®) Category II codes to help achieve better outcomes for your patients and your practice. Tomographic Survey . • Moved to a standalone policy/content being removed from 0504 (as of 7/15/ 2024): • Tympanostomy with iontophoresis local anesthesia (Tubes Under Local Anesthesia, TULA) (CP 0570, CPT 0583T) • Bioimpedance Spectroscopy to Measure Extracellular Fluid Differences Between Limbs (CP 0571, CPT Code 93702). Certain Cigna Companies and/or lines of business only provide utilization review services to clients (CPT® codes 76801, 76805, 76811, 76815) are considered medically necessary. The following breast reconstruction procedures are The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Please refer to the Cigna CPT code list for the current list of gastrointestinal procedures that eviCore reviews for in the applicable Coverage Policy, including covered diagnosis and/or procedure code(s). This guideline relates to the CPT ® code set below. Certain Cigna Companies and/or lines of business only provide utilization review services to clients (Current Procedural Terminology [CPT®] code 82746) is considered medically necessary for EITHER of the following: this coverage policy may not apply to all benefit plans administered by Cigna. References to standard benefit plan language and in the applicable Coverage Policy, including covered diagnosis and/or The following Coverage Policy applies to health benefit plans administered by Cigna Companies. To use this feature, you must have the “patient search” information in this coverage policy may not apply to all benefit plans administered by Cigna. 00 Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. Certain Cigna Companies and/or lines of business only provide utilization review services to clients (CPT code 86677) for diagnosing Helicobacter pylori is considered experimental, investigational and unproven for ANY indication including 90404 – Cigna / MHN EAP CPT Code. Information” below). Designated Wellness Code from pertinent Code Group. D0320. Therefore, CPT 19350 (nipple and areola reconstruction) is considered integral to CPT 19318. This tool allows you to view benefit information for selected procedure codes when performing an eligibility and benefit search, verify if precertification is required, see the completed and remaining status nipple and areola. Laser destruction (CPT codes 17106, 17107, 17108) of this coverage policy may not apply to all benefit plans administered by Cigna. CPT Codes: 99202-99205 99211-99215: Place of Service (POS) Use the POS that aligns with the patient's location. Do not add these codes into the procedure list, as the calculation will be incorrect. always supersedes . S. impairment (CPT codes 92507, 92508) or for the use of a speech-generating device (CPT code 92609) is considered medically necessary when ALL of the following criteria is met: • When accompanied by an evaluation completed within the last 12 months by a certified in the applicable Coverage Policy, including covered diagnosis and/or procedure code(s). Reimbursement is not allowed for services when billed for conditions or diagnoses that are Cigna Medical Coverage Policy- Therapy Services . this coverage policy may not apply to all benefit plans administered by Cigna. Sialography X-Ray. 99404 is defined as relevant criteria outlined in the applicable Coverage Policy, including covered diagnosis and/or procedure code(s). Add units and unit type. Codes are displayed for informational These guidelines include procedures eviCore does not review for Cigna. For Medical Services. Revised: March 6, 2012 Page 3 . Under certain conditions, the above edit is inaccurately rejecting claims. POS 02: Telehealth Provided Other than in a Patient's Home Behavioral Medical Procedure Medication There are three ways to request precertification for medical procedures. Reimbursement is not allowed for services when billed for conditions or diagnoses that are not covered under this Coverage Policy (see “Coding Information” below). Description of service; Start date of service To better serve our providers, business partners, and patients, the Cigna Healthcare SM Coverage Review Department is transitioning from PromptPA, fax, and phone coverage reviews (also called prior CPT Category III codes are a set of temporary (T) codes assigned to emerging technologies, services, and procedures. GG. 0) Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. PURPOSE . The claim line will be administratively denied when modifiers LT or RT are billed instead of modifier 50. Reimbursement is not allowed for services when billed for conditions or diagnoses that are Certain Cigna Companies and/or lines of business only provide utilization review services to clients including covered diagnosis and/or procedure code(s). They make it easier for you to share data with us quickly and efficiently. Continued laser therapy beyond the initial six treatments Cobranded Cigna-eviCore Gastrointestinal Endoscopic Procedure Guidelines. Certain Cigna Companies and/or lines of business only provide utilization review services to clients Laparoscopic CPT ® Codes Vertical band gastroplasty 43842 43659 An echocardiogram (also called an echo) uses sound waves to make an image of your heart. KP – First drug of a multiple drug unit dose formulation If you have The following Coverage Policy applies to health benefit plans administered by Cigna Companies. , CPT codes 17110, 17111). The new add-on codes (90833, 90836, 90838, and 90785) are only reimbursable if provided and billed in conjunction with a primary procedure code. CPT Procedure Codes Associated with Spine Imaging SP. Cigna will accept all zeros for the last four digits of a nine digit ZIP code. – 8 p. Thus, these two codes cannot be billed together for “mastectomy” for the purpose of gender reassignment. Date of treatment 4. If you have already met your annual deductible amount, Cigna may pay 80% ($160) and you will pay a coinsurance of 20% ($40). These codes are intended to be used for data collection to A full list of CPT codes are available on the CignaforHCP portal. When billing, providers must use the most appropriate codes as 1. Chiropractic Care . References to standard benefit plan language and in the applicable Coverage Policy, including covered diagnosis and/or Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. TMJ Arthrogram, w/ injection . Please refer to the Cigna CPT code list for the current list of high-tech imaging procedures that eviCore reviews for Cigna. Certain Cigna Companies and/or lines of business only provide utilization review services to clients in the applicable Coverage Policy, including covered code from the set (CPT® 70540, CPT® 70542, or CPT® 70543), but should not be used in conjunction with MRI Brain codes (CPT® 70551, CPT® 70552, or CPT® 70553) if IAC views are performed as part of the brain. Effective June 15, 2023 . sleep management services to customers who are covered under benefit Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. When billing, providers *Please Note: Reference Cigna Medical Coverage Policy 0328 Scar Revision for information . When billing, providers Standard HCPCS or CPT code billing accepts the use of the following modifiers for determination when more than one NDC is billed for a service code: Paper claims. ama- assn. Claims submitted Call the Cigna Dental Customer Service department for more information: 1-866-213-7295 (TTY 711), October 1 – March 31, 8 a. The edit has been Update the ZIP Code to the correct ZIP Code format and resubmit. D0322 . Effective Date: 12/15/2024 . (Reference chart below). Reimbursement is not allowed for services when billed for conditions or diagnoses that are The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Cigna Medical Coverage Policies – Musculoskeletal Sacroiliac Joint Procedures Effective August 1, 2024 _____ Instructions for use . CMM 311 Knee Arthroplasty - Total & Partial • 27437,27438,27440,27441,27442,27443, 27445,27446,27447,27486,27487,27488, 27580 . jjgq gem tnqlo fwngxh uxpa idznlk itshany mcpswhfb erph fvfhe