Cigna February 2018 Medical Policy & Pharmacy Updates

Click here to view the Cigna Medical Policy Updates »

February 2018 Medical Policy & Pharmacy Policy Updates

• R12 Facility Routine Services, Supplies, and Equipment Policy *
• Intraoperative Neurophysiological Monitoring (IONM) – (0509)
• Peripheral Nerve Destruction for Pain Conditions (0525)
• Headache and Occipital Neuralgia Treatment (0063)
• Radiofrequency Joint Ablations/Denervation (CMM 208)
• Plantar Fasciitis Treatments (0097)
• MAS – Modifiers 62, 66, 80, 81, 82, and AS Assistant Surgeon, Assistant at Surgery, Co-Surgeon (Two Surgeons), and Surgical Team *
• Global Surgical Package and Related Modifiers (24, 54, 55, 56, 57, 58, 76, 77, 78, and 79) *
• Omnibus Reimbursement Policy (R24) *
• A4566 Electrodes Per Pair Frequency Limit
• Pneumatic Compression Devices and Compression Garments (0354)
• Omnibus Reimbursement Policy (R24) *
• Outpatient UB -Clinic Not Covered
• Peripheral Nerve Destruction for Pain Conditions – (0525)
• Bone, Cartilage and Ligament Graft Substitutes – (0118)
• Drug Testing – (0513)
• Headache and Occipital Neuralgia Treatment – (0063)
• Plantar Fasciitis Treatments – (0097)
• Pneumatic Compression Devices and Compression Garments – (0354)
• Ventricular Assist Devices (VADs) and Percutaneous Cardiac Support Systems – (0054)
• Chiropractic Care – (0267)
• Chiropractic Care – (CPG287)
• Preventive Care Services – (A004)
• Cerliponase Alfa – (1807)
• Denosumab – (1212)
• Drugs/Biologics Not Covered Unless Approved Under Medical Necessity Review – Employer Group Plans: Standard Prescription Drug List and Performance Prescription Drug List – (1601)
• Drugs/Biologics Not Covered Unless Approved Under Medical Necessity Review – Employer Group Plans: Value Prescription Drug List and Advantage Prescription Drug List – (1602)
• Filgrastim – (1611)
• Implantable Hormone Pellets – (1504)
• Modafinil/Armodafinil – (1501)
• Oncology Medications – (1403)
• Pharmacy Prior Authorization – (1407)
• Quantity Limitations – (1201)
• Step Therapy – (1109)
• Abatacept – (6112)
• Anakinra – (4063)
• Anti-Tumor Necrosis Factor Therapy – (9014)
• Interleukin-12/23 and 17 Antagonists – (1017)
• Natalizumab for Crohn’s Disease – (6017)
• Tocilizumab – (1024)
• Tofacitinib – (1410)
• Vedolizumab – (1502)

Click here to view the Cigna Medical Policy Updates »

Policy Alerts monitors Commercial and Medicare medical policies for changes. While Payers typically update medical policies annually, there are many reasons why a Payer might review or update a policy. When reviews occur out of cycle, they may go unnoticed. Policy Alerts keeps you informed of upcoming and unexpected coverage changes affecting your product. Quickly understanding the changes Payers make can help you adjust reimbursement strategies impacting your business.

Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on Payer decisions in real-time. Whenever changes occur, email notifications containing a summary of those changes are delivered to your inbox. Clients can access detailed coverage reports and medical policies on the interactive Dashboard portal. Save time and keep focused on the important Payer medical policy reviews and coverage decisions affecting your product!

Policy Alerts takes a client-focused hands-on approach and works hard to provide our customers with helpful insights and actionable analytics over raw data. We understand what our clients need and we are dedicated to making sure we provide timely, accurate and always up-to-date reports that can be used to implement and support a successful reimbursement strategy.

Health economic and reimbursement information provided by Policy Alerts is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.