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
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