CIGNA Revises Modifier (-25 and -59) Policy

CIGNA changed its policy to require providers to submit supporting documentation for any claims with procedures and services that are appended with a CPT modifier 25 or 59.  As of April 20, 2009, CIGNA planned to require documentation for approximately 17,000 NCCI code pairs.   After listening to numerous providers and professional medical societies including the American College of Cardiology and the AMA, CIGNA has decided to significantly reducing the number of NCCI code pairs for which it requires documentation to fewer than 500 (less than 5 percent of CIGNA's total claims).  CIGNA will delay full implementation of this program until April 27, 2009.

CIGNA will also provide helpful hints to ensure the supporting documentation physicians submit via fax or mail for these NCCI code pairs contains the appropriate information to successfully match the documentation with the electronic claim submission. In the meantime, please instruct physicians and their practice staff to check Box 19/Loop 3200 on their claim submission to indicate that they submitted supporting documentation. Supporting documentation can be faxed to CIGNA at (570) 496-2945 or sent via mail to the CIGNA address on the back of the patient’s ID card.

Here are some important instructions for your practice:  

As of April 20:

• CIGNA was pleased to report the mandatory submission of documentation for NCCI code pairs appended with CPT modifier 59 will be delayed until April 27, 2009. Beginning April 27, the list of code combinations that require supporting documentation for modifier 59 will be significantly reduced.
• Documentation submission requirements for NCCI code pair edits appended with CPT modifier 25 will be active through April 24. Physicians and their practice staff must choose to either submit these code pairs with documentation or postpone submission to the following week. Physicians and their practice staff should remember to always appropriately document the performance of procedures and services prior to submitting a claim. Beginning April 27, the list of code combinations that require supporting documentation for modifier 25 will also be significantly reduced.

Once the revised list is released, the ACC will highlight the code pairs most frequently billed by cardiologists.

Please instruct your practice staff to keep visiting www.cignaforhcp.com for the revised list of which NCCI code pairs that will require supporting documentation with the claims submission when appended with a CPT modifier 25 or 59. For the complete list of current code combinations that require supporting documentation when modifiers 25 or 59 are billed, log in to the secure CIGNA for Health Care Professionals Web site (www.cignaforhcp.com) and select “Resources” then “Claim Editing Procedures.” The updated code combination lists will be available online prior to April 27.

Physicians who are not currently registered for the CIGNA for Health Care Professionals Web site will need to complete the registration process to log on. They can go to www.cignaforhcp.com and select “Register Now,” located in the left side bar.