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Date: July 22,2026
Cigna Implements Site of Care Policy for Outpatient Therapy
Cigna will be implementing a site of care policy for outpatient therapy services. What does this actually mean for private practices and hospital outpatient therapy departments? In this article, I will answer the following questions:
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This is a major trend to restrict access to patient choice. Hospitals offer a better continuum of care being able to see patient from the time of admission to the progression of care.
Keep in mind, for many orthopedic conditions, there is no hospital admission. For those orthopedic conditions that require surgery, typically, it is same day surgery and patient is home later in the day. So Cigna is questioning why should they reimburse a hospital 3-5 times what they reimburse a private practice therapy clinic.
Does this apply to all Cigna products including Medicare Advantage?
Read Page 1 under Instructions for Use as to what plans and policies it applies to.
Rick, can you clarify two things with this policy change:
1. This applies to Cigna and not Cigna’s Medicare Advantage plans?
2. Would access to therapists that have OCS certification and/or NDT certifications qualify as specialized OT/PT?
Thank you!
1. Read Page 1 under Instructions for Use as to what plans and policies it applies to. I would also recommend you attend one of the training sessions and ask that question
2. You would need to make that decision.
Great article. Very timely.
Thank you! ASH and Cigna did have issues with their scheduled training call today. Hopefully, they get that corrected.
Sorry but we don’t see 3-5 times reimbursement from Cigna. The rates for Cigna in Hospital OP are negotiated. Also for most of our Joint replacements we provide Prehab followed by same day surgery then therapy at Home. Those programs generally can’t be provided by most independent practices.
With Cigna applying this arbitrary label of “not medically necessary“ these patients will no longer be able to receive the service.
You may not, but other hospitals do. There are private practices in NY and Florida that are being reimbursed $45-$60 per visit while the hospitals are being reimbursed $150 – $250 for the same visit.
Private practices do prehab and many therapists have started private practices that are mobile and see patients in their home. In fact. private practices see more patients in their home as an outpatient than hospital outpatient departments do.
What is a more appropriate amount for a visit $45 or $150? This is why the profession struggles because they accept these low rates. Insurance is working to cut out the hospitals. Then they will further cut the PT in Private practice. Retiring soon.
Thanks for that information. We are a free-standing PT facility that has the overhead harness system, so we could take those patients, also.