July 26, 2024
To support access to quality, cost-effective care for your patients with a medical plan administered by Cigna Healthcare, we routinely review clinical, reimbursement, and administrative policies for potential updates. As a reminder, reimbursement and modifier policies apply to all claims, including those for your patients with “G” ID cards.
Planned Cigna Healthcare Medicare Advantage policy updates*
| Policy name | Update | Effective date |
| Modifier 50 Bilateral Procedures (MAM50) | We will administratively deny bilateral procedure codes when billed without the required modifier, LT (left side), RT (right side) or 50, as appropriate. | August 17, 2024, for dates of service on or after this date. |
| Emergency Room Services (MAR36) | We will review facility claims submitted with emergency room evaluation and management Current Procedural Terminology (CPT®) code 99285 for billing coding and accuracy. Claims may be adjusted and reimbursed at a more appropriate CPT code level. | August 25, 2025, for dates of service on or after this date. |
* Please note that the planned updates are subject to change. For the most up-to-date information, please visit the Cigna for Health Care Professionals website (CignaforHCP.com).
Additional information
For more information about our monthly policy updates, visit CignaforHCP.com > Resources > Coverage Policies > Policy Updates.
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