Cigna to stop paying for consultation codes

If you provide consultations to Cigna members, be aware that Cigna will soon no longer pay those codes. For claims processed on or after Oct. 19, Cigna said in a recent payment update that it will begin denying claims billed with CPT codes for office consultations (99241-99245) and inpatient consultations (99251-99255).

Instead, the company says physicians should submit (or resubmit, in case of a denial) claims with the appropriate non-consultative evaluation and management (E/M) codes that describe the service. For instance, a consultation done in the office would be reported with the appropriate office visit E/M code (99201-99215).

Medicare adopted a similar policy in 2010, at which point the Centers for Medicare & Medicaid Services (CMS) increased the relative value of the other E/M codes physicians must use in lieu of the consultation codes. No word yet on whether Cigna will follow CMS’s lead.

– Kent Moore, Senior Strategist for Physician Payment at the American Academy of Family Physicians

Posted on Aug 27, 2019 by Kent Moore