Policy Updates February 2015

The information outlines updates to policies that are effective this month. To view the updated policy in its entirety, select the policy name.

Policy Name Affected Physicians Updates effective February 16, 2015
Allergy Testing and Non-Pharmacologic Treatment
  • Allergists / Immunologists
  • Family Practice Physicians
  • Internists
  • Otolaryngologists
  • Pediatricians

Cigna will apply maximum daily/yearly antigen preparation limits of >84 units/day and 120 units/year to CPT code 95165.

Units billed in excess of > 84 units/day and > 120 units/year will deny as not medically necessary. Medical necessity appeal rights will be provided.

Autonomic Nervous System Testing
  • Cardiologists
  • Internists
  • Neurologists
  • Pediatricians

CPT® codes 95921, 95922, 95923, 95924, and 95943 will be covered for specific diagnosis codes listed as medically necessary and denied as experimental, investigational, or unproven (EIU) for all other diagnosis codes.

Mechanical Devices for the Treatment of Back Pain - (0140)
  • Chiropractors
  • Orthopedists

HCPCS DME code E0941 will be denied as always EIU for all customers.

The appearance of an item or procedure in this update indicates only that we have recently adopted or revised a policy. It does not imply that we provide coverage for the items or procedures listed. In the event of an inconsistency or conflict between the information provided and the posted policy, the provisions of the posted policy will prevail.