After significant pushback from the AMA, ACR and other medical societies, Cigna has delayed implementation of changes to its modifier 25 reimbursement policy, originally scheduled to take effect May 25.
ACR Insurance Subcommittee Tackles Known Issues
During a busy start to 2023, the ISC has been advocating with payers to address multiple coverage and reimbursement challenges facing rheumatology practices, including Cigna’s modifier 25 requirements, hydroxychloroquine access and coverage for apremilast combination therapy.
Cigna Delays Modifier 25 Policy Change for Evaluation & Management Services
Cigna will not move forward with changes to their reimbursement policy for evaluation and management (E/M) codes submitted with modifier 25 as originally scheduled.
Reimbursement Options for Services Without Direct Patient Contact
Beginning in October 2019, two major commercial payers, UnitedHealthcare and Cigna, discontinued payment for consultation services. The CPT codes affected include 99241–99245 and 99251–99255. The payers have instructed providers to instead bill the non-consultative evaluation and management (E/M) codes that best describe the services performed. If the non-face-to-face service goes beyond the usual time a…
ACR Leads Coalition Opposing Cigna’s Elimination of Consultation Codes
In a letter co-signed by other Cognitive Specialty Coalition organizations, the ACR is requesting at least a one-year delay to better coordinate payer changes with recent federal initiatives.
ACR Fights Cigna Decision to Eliminate Consultation Codes
As of Oct. 19, Cigna will deny claims billed with codes for consultation services, making it the second payer to discontinue payment for evaluation and management codes in 2019.
Cigna Closes $54 Billion Purchase of Express Scripts
NEW YORK (Reuters)—Cigna Corp on Thursday closed its $54-billion deal to buy Express Scripts Holding Co, creating one of the biggest providers of pharmacy benefits and insurance plans in the United States, a combination it says will help it improve healthcare coordination and cut costs. Cigna’s deal puts it in direct competition with two other…
Health Insurer Cigna to Buy Express Scripts for about $54 Billion
(Reuters)— U.S. health insurer Cigna Corp said on Thursday it would buy pharmacy benefits manager Express Scripts Holding Co for about $54 billion, a tie-up that reflects pressure on healthcare companies to grow bigger to cut costs. The move follows the $69-billion merger of insurer Aetna Inc and one of Express Scripts’ biggest rivals, CVS…
Health Plans Enact Coverage Policies for Remicade & Infliximab Biosimilars
Several major health plans have recently enacted policies regarding coverage status for Remicade (infliximab) and its biosimilars, Inflectra (infliximab-dyyb) and Renflexis (infliximab-abda). Most of these plans are limiting coverage for the biosimilar products to very specific circumstances. Some have also begun denying claims for biosimilars and instructing patients to switch to Remicade. The plans implementing…
Cigna to End OxyContin Painkiller Coverage, Signs Contract for Alternative
(Reuters)—Amid a growing U.S. opioid addiction, health insurer Cigna Corp will stop covering OxyContin, the opioid painkiller sold by Purdue Pharma LP, as of January 1 and will instead cover an equivalent with a formulation less vulnerable to abuse, the company said on Wednesday. The insurer has signed a “value-based contract” with Collegium Pharmaceutical Inc…