Wiki CIGNA

[Phillips123]

My office is having problems getting Cigna to pay for Preventative visit, 99395 and office visit, 99205-99213. I am wondering if anyone has any information on why they are doing this and if your office is also having this problem. Thanks

 

[amyjph]

Do you routinely check the policies and updates they put out? That's usually where the answers are. Most (if not all) payers have a specific policy for E/M & preventive billed on the same date.
Other than that, what are the service dates it started? Is it all claims or just some claims? Do they have a 25 modifier on them? Have they updated or changed a policy, etc.?

https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/ad_a004_administrativepolicy_preventive_care_services.pdf?_gl=1*o0w0yq*_gcl_au*NTgxMTQ2NTY2LjE3MDIyMTExNzg.

CHCP - Resources - Policy Updates

static.cigna.com

https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/claimCodeEdit/CodeEditingGuidelines.pdf

https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/clinReimPolsModifiers/Notifications/Modifier_25_Significant_Separately_Identifiable_Evaluation_and_Management.pdf

This was the specific policy however, it is offline right now: https://static.cigna.com/assets/chc...Problem_Based_E_M_Service_On_Same_Day_HCP.pdf

This is old but an example: https://ppn-staging.symphonic-sites.com/wp-content/uploads/CignaPreventiveServiceProblemSameDay.pdf