We routinely review Evernorth Behavioral Health and Cigna Healthcare coverage, reimbursement, and administrative policies for potential updates while taking into consideration evidence-based medicine, professional society recommendations, Centers for Medicare & Medicaid Services (CMS) guidance, industry standards, and our other existing policies.

As a result of a recent review, an update was made to the Code Editing Policy and Guidelines, which impacts both our medical and behavioral health provider network. The update, effective July 14, included 17 Current Procedural Terminology (CPT®) and three Healthcare Common Procedure Coding System (HCPCS) codes for behavioral health professional and outpatient facility services.

What this means to you
For dates of service on or after July 14, 2024, the following codes will be administratively denied when billed at a frequency greater than the medically unlikely edit set by CMS, by the same provider, for the same patient, on the same day. Please note that denials will affect the claim line only and will include administrative appeal rights.

• CPT codes: 90845-90847, 90849, 90853, 90863, 96146, 97151-97158, 0362T, and 0373T

• HCPCS codes: G0447, G0451, and G0473

Additional information

For more information on this topic, please visit the Code Editing Policy and Guidelines. For additional questions, you may contact Provider Services at 800.926.2273.