By: Amy Keil, Client Manager
Letters from Cigna dated on or around April 1st, 2022, are not an April Fools’ Prank. It appears that Cigna is attempting a new additional tactic to manage their payment of the Professional Component of Clinical Pathology (PCCP). In this letter Cigna has indicated that their intent is to cap the reimbursement at $5.00 per test rather than stopping payment altogether. Cigna states that they took one or more of the following into consideration to establish this new policy.
- Cigna’s existing policies
- Industry standards
- Centers for Medicare and Medicaid Services (CMS) guidance
- Professional Society recommendations
- Evidence-based medicine
- 3 = Technical component only codes – 26 and TC modifiers are not valid
- 9 = Concept of a professional/technical component does not apply – 26 and TC modifiers are not valid