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CIGNA Clinical, Reimbursement and Administrative Policy Updates

Recent News


CIGNA routinely reviews clinical, reimbursement and administrative policies, medical coverage positions, and the precertification process and requirements. The following table provides a summary of recent updates. Additional information is available on CIGNA's secure website for Health Care Professionals.

Policy and Effective Date Update
Precertification Requirement – Injectables
May 1, 2011		 Added injectable drug codes:  J9035, bevacizumab, 10 mg (Avastin); J9055, cetuximab, 10 mg (Erbitux); J1300, eculizumab, 10 mg (Soliris); J9303, panitumumab, 10 mg (Vectibix); J9310, rituximab, 100 mg (RituXan); J9355, trastuzumab, 10 mg (Herceptin)
Contiguous Body Parts
July 1, 2011
  • The highest allowable reimbursement amount will be paid at 100% of the fee schedule, maximum reimbursable charge (MRC), or usual and customary (U&C) rate, while all subsequent procedures will be subject to the multiple radiology reduction and will be reimbursed at 50%.
  • Added CPT codes to families: Family 1 - 76870; Family 2 - 74261, 74262, 75571, 75572, 75573 and 75574; Family 4 - 75557, 75559, 75561, 75563, 77058 and 77059; Family 5 - 70336 and 70554
Precertification Requirement – Nuclear Cardiac Services
July 1, 2011		 Nuclear Cardiac Services (SPECT) will require precertification.  Affected CPT codes are 78460-78499, A9502, and A9505.
Transthoracic Echocardiography
July 1, 2011		 CIGNA will reimburse transthoracic echocardiograms (TTEs) only when performed for proven and appropriate indications.  The TTE policy and criteria will rely on evidence-based review of literature, as well as the recommendations of professional organizations (e.g, the American College of Cardiology).  Precertification of TTEs will not be required.  Denied services will be eligible for clinical appeal.