November 21, 2024
Please be aware of an important change to the Cigna HealthcareSM Medicare Advantage provider manual to include information on facility fee reimbursement. Cigna Healthcare will not reimburse facilities for outpatient clinic fees or facility fees used to provide E&M services if billed on a UB-04 claim form, as defined by the Center for Medicare and Medicaid Services, by way of example and without limitation, these services currently include Healthcare Common Procedure Coding System (HCPCS) codes 99201 – 99205, 99211 – 99215, or G0463 when billed in combination with revenue code 0510. Customers will only be responsible for the physician office visit cost share. Refer to the provider manual for additional information.
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