Cigna Will Not Reimburse for More Than 4 Units

August 29, 2022
Rick Gawenda

Cigna has announced a new payment policy that has implications for outpatient physical and occupational therapy services. Effective with dates of services on and after

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  1. Is the 4 unit maximum per discipline (PT, OT) separate? Or is it 4 units total per day regardless of discipline?

  2. How would the 15% reduction effect outpatient therapy in a Critical access hospital, which is not impacted by the CMS reduction? Would we (Critical Access) have to just report the CO / CQ modifiers for Cigna patients then?

    1. I would recommend you log into the portal and review the policy. You can also contact Cigna Customer Service at 800.88Cigna (882.4462).

  3. We currently have a denial regarding this issue. PT and OT combined billed over 4 units/day, but since we are a SNF billing a UB04 with 1 NPI, they are combining disciplines. IE: they are considering “provider” to be the SNF, not PT or OT. We are appealing further, but that has been their decision on 2 levels of denial. Good times.