After a recent review in coverage, reimbursement, and administrative policies, Cigna has published several changes that will go live starting this week. Two of these updates will directly impact pathology practices and laboratories:
Flow Cytometry Policy Update
Claims with dates of service on or after May 20, 2019 will be subject to review for medical necessity. Affected CPT codes include: 86355, 86356, 86357, 86359, 86360, 86361, 86367, 88182, 88184, 88185, 88187, 88188, and 88189.
Flow cytometry is considered medically necessary for the evaluation of any of the following:
• HIV Infection
• Leukemia or Lymphoma
• Organ Transplants
• Primary Immunodeficiencies
While there is no NCD published by CMS, this Cigna Coverage Policy follows the same scope as published LCDs. Please reference your local Medicare Contractor’s LCD policy to understand how this update impacts your laboratory.
Pass-through bills for laboratory services will be denied, effective May 21, 2019
Cigna will no longer reimburse for pass-through laboratory services. Pass-through billing occurs when providers bill for laboratory services they have not actually performed. These services are submitted with a Place of Service 11 (office setting) and have a modifier 90. The change will affect all laboratory service codes billed with modifier 90 in POS 11. Moving forward, the processing laboratories should bill Cigna directly in order to receive reimbursement.