The ACR recently led a Cognitive Specialty Coalition (CSC) sign-on letter to Cigna opposing the payer’s decision to discontinue reimbursement for consultation codes as of Oct. 19.
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The letter noted the policy is inconsistent with the current healthcare environment, which is moving toward a more appropriate valuation of cognitive care. The CMS recently took the lead in this area by proposing an increase in reimbursement for many evaluation and management services in the CY 2020 Revisions to Payment Policies Under the Physician Fee Schedule proposed rule. The ACR and other CSC members requested that, at a minimum, Cigna delay the policy for one year to allow for thoughtful and appropriate updates to the overall valuation of cognitive care in line with the recent CMS initiatives.
Co-signers included the American Academy of Allergy, Asthma & Immunology, the American Academy of Neurology, the American Association of Clinical Endocrinologists, the American Psychiatric Association, the Endocrine Society, the Infectious Diseases Society of America and the North American Neuro-Ophthalmology Society.
The new Cigna policy on evaluation and management (R30) affects all claims billed on or after Oct. 19. Claims billed with CPT codes for consultation services—including 99241, 99242, 99243, 99244,99245, 99251, 99252, 99253, 99254 and 99255—will be denied as invalid.
Cigna is the second major payer to discontinue payment for consultation services in 2019. UnitedHealthcare announced earlier this year that it would also eliminate the consultation codes in two phases. On June 1, UHC discontinued payment for practices whose contracted rates are based on a stated year 2010 or later Medicare fee schedule. As of Oct. 1, it has completely eliminated reimbursement for consultation codes for all practices. Medicare previously discontinued payment for consultation services in 2010.
The ACR is very concerned about the impact of these changes on rheumatology practices and will continue to oppose any payer efforts to eliminate reimbursement for consultation services, while advocating for appropriate recognition and compensation of rheumatologists’ expertise and training. The ACR will also introduce a resolution on this issue during the AMA House of Delegates meeting in November.
If you have questions regarding this policy or other insurance coverage concerns, contact [email protected].