CIGNA Increases Physician Payment for Vaccines

Family physicians who have contracts with CIGNA HealthCare may see a little more money in their pockets because of what CIGNA calls a "significant" increase in its national reimbursement fee schedule for vaccines.

The new rates, which will exceed vaccine manufacturers' acquisition prices, became effective Jan. 15. The rates apply to all physicians -- across all specialties -- who adhere to CIGNA's national fee schedule and who stock and administer preventive vaccines in their offices.

Affected physicians can find details about the reimbursement rates on CIGNA's secure Web site. Physicians need to enter their CIGNA user ID and password.

In addition, according to CIGNA, the company currently is reviewing its national reimbursement rates for administering vaccine and expects to announce a decision on that issue later in 2007.

AAFP President Rick Kellerman, M.D., of Wichita, Kan., said CIGNA's announcement was a move in the right direction for everyone involved. "Immunizations are cost-effective preventive care and should be administered in the patient's medical home," said Kellerman. "Making sure that physicians are fairly paid to provide that care is vitally important."

The effort to increase vaccine reimbursement was spearheaded by the American Academy of Pediatrics, which successfully argued that physicians have costs involved in the purchasing and storage of vaccines that are over and above the cost of simply acquiring the vaccine from the manufacturer.

"Providing a fair reimbursement structure for vaccines, including the office costs associated with ordering, storing and insuring vaccines, is an indication of CIGNA's commitment to ensuring that our members have access to high-quality preventive services in the setting of their primary care physicians' office," said CIGNA Medical Officer Douglas Hadley, M.D.

Hadley said CIGNA "will continue to work with the leadership of the AAFP to address issues of importance to family physicians and our members."

Outstanding among those issues, said Kellerman, is the Academy's request that CIGNA pay physicians for both preventive and evaluation and management services when both these medical services are delivered to a patient during the same office visit.