Policy Updates January 2019
Important Information
These policies apply to health benefit plans administered by Cigna companies and are intended to provide guidance in interpreting certain standard Cigna benefit plans. Please note, the terms of a customer's particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these policies are based. For example, a customer's benefit plan document may contain a specific exclusion related to a topic addressed in a policy. In the event of a conflict, a customer's benefit plan document always supersedes the information in the policies.
In the absence of a controlling federal or state coverage mandate, benefits are ultimately determined by the terms of the applicable benefit plan document. Coverage determinations in each specific instance require consideration of 1) the terms of the applicable benefit plan document in effect on the date of service; 2) any applicable laws/regulations; 3) any relevant collateral source materials including these policies and; 4) the specific facts of the particular situation. These policies relate exclusively to the administration of health benefit plans and are not recommendations for treatment and should never be used as treatment guidelines. In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations.
Note - Some updates require the user to be logged into the website using username and password. Each secure section or policy will be marked with an asterisk *
| Policies | Update to Coverage | |
|---|---|---|
| We are changing how we reimburse for the following policy: | ||
| Cardiac Electrophysiological (EP) Studies – (0532) |
|
| Policies | Status | Details |
|---|---|---|
| Cardiac Electrophysiological (EP) Studies – (0532) | New |
|
| Percutaneous Revascularization of the Lower Extremities in Adults – (0537) | New |
|
| Prosthetic Devices – (0536) | New |
|
| New |
|
|
| Hospital Beds and Accessories - (0273) | Modified |
|
| Intervertebral Disc (IVD) Prosthesis - (0104) | Modified |
|
| Lumbar Fusion for Spinal Instability and Degenerative Disc Conditions, Including Sacroiliac Fusion - (0303) | Modified |
|
| Omnibus Codes - (0504) | Modified |
|
| Stem Cell Transplantation: Blood Cancers – (0533) | Modified |
|
| Vitamin D Testing - (0526) | Modified |
|
| Five policies retired and replaced with Stem Cell Transplantation: Solid Tumors – (0534) | Retired |
|
| Two policies retired and replaced with Prosthetic Devices – (0536) | Retired |
|
| Policies | Status | Details |
|---|---|---|
| No updates for January 2019. |
| Policies | Status | Details |
|---|---|---|
| Modified |
|
| Policies | Status | Details |
|---|---|---|
| Preventive Care Services - (A004) | Modified |
|
| Policies | Status | Details |
|---|---|---|
| Elagolix - (P0065) | New |
|
| Hydroxyurea Tablet – (P0052) | New |
|
| Enzyme Related Therapies - (1319) | Modified |
|
| Hepatitis C Therapy - (1316) | Modified |
|
| Ivabradine – (P0010) | Modified |
|
| Oncology Medications – (1403) | Modified |
|
| Testosterone Therapy - (1503) | Modified |
|
| Two policies retired on January 1, 2019. | Retired |
|
| Policies | Status | Details |
|---|---|---|
| No updates for January 2019. |
| Policies | Status | Details |
|---|---|---|
| Updated Master Precertification List |
| Policies | Status | Details |
|---|---|---|
| No updates for January 2019. |
| Policies | Status | Details |
|---|---|---|
| Code Edit and Policy Guidelines |
|
These policies apply to health benefit plans administered by Cigna companies and are intended to provide guidance in interpreting certain standard Cigna benefit plans. Please note, the terms of a customer's particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD) or similar plan document] may differ significantly from the standard benefit plans upon which these policies are based. For example, a customer's benefit plan document may contain a specific exclusion related to a topic addressed in a policy. In the event of a conflict, a customer's benefit plan document always supersedes the information in the policies.
In the absence of a controlling federal or state coverage mandate, benefits are ultimately determined by the terms of the applicable benefit plan document. Coverage determinations in each specific instance require consideration of 1) the terms of the applicable benefit plan document in effect on the date of service; 2) any applicable laws/regulations; 3) any relevant collateral source materials including these policies and; 4) the specific facts of the particular situation. These policies relate exclusively to the administration of health benefit plans and are not recommendations for treatment and should never be used as treatment guidelines. In certain markets, delegated vendor guidelines may be used to support medical necessity and other coverage determinations.