Cigna Will Not Reimburse for More Than 4 Units
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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Is the 4 unit maximum per discipline (PT, OT) separate? Or is it 4 units total per day regardless of discipline?
I have added an additional sentence to the article.
Rick…do you understand this limit to be 4 units total, between PT/OT or per discipline?
I have added an additional sentence to the article.
Is that 4 units total, between PT and OT?
I have added an additional sentence to the article.
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?
You would need to check with Cigna to see if they are implementing the CQ/CO modifiers for CAHs.
Rick, how does this policy effect those contracted with Cigna through ASH?
I would recommend you log into the CignaforHCP.com portal and review the policy. You can also contact Cigna Customer Service at 800.88Cigna (882.4462).
Does this apply to Cigna supplemental plans that are secondary to Medicare?
No as you would follow Medicare rules and regulations since Medicare is primary.
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.