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G0416 Prostate Update for Cigna: Go-Live August 18, 2020

  • Director of Anatomic Pathology Development

As announced by Cigna earlier this summer, beginning August 18, 2020 Cigna will require pathology groups to submit G0416 for prostate needle biopsies instead of 88305. Prostate biopsies will no longer be reimbursed using the 88305.

XIFIN confirmed with Cigna that this applies to all Cigna plans, not just a select few. Commercial payors aligning with CMS guidelines on G codes is becoming a trend and carries financial impacts to pathology practices nationwide, particularly when billing secondary insurances, where some require use of a G code and others continue to require an 88 code for reimbursement. Additionally, since G codes typically reimburse at a lower rate than billing individual 88305s, groups need to evaluate, and budget for, any financial impact the conversion will have on their business.

Source:

https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/clinReimPolsModifiers/Notifications/R24_
Omnibus_Reimbursement_Policy.pdf


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