As you may already be aware, Cigna has released a reimbursement policy update stating that effective July 10, 2021, they will be denying reimbursement for CPT codes billed with modifier 26 when applied inappropriately based on the CMS National Physician Fee Schedule. As we can all attest, the professional component of clinical pathology services are critical to the accurate diagnosis and treatment of patients. The policy change would affect pathologists in Florida along with many other states including Arizona, California, Colorado, Illinois, Kansas, Missouri, North Carolina, Pennsylvania, Tennessee, Utah, and Virginia.
In response to the notice from Cigna, the Florida Society of Pathologists Legislative and Governmental Affairs Committee has met to discuss how best to support FSP members on this issue. The FSP is currently working on a letter of appeal to Cigna for their immediate review and reversal of the policy update. In addition, the FSP has communicated with the College of American Pathologists and the Florida Medical Association to discuss collaboration opportunities to combat this issue. The CAP has engaged Cigna and is requesting a meeting to further discuss the proposed change.
The FSP will keep members informed of the issue and any developments regarding Cigna’s response to our letter. We encourage all FSP members to challenge Cigna’s implementation of this policy. FSP members that are currently contracted with Cigna should consider their relationship to Cigna and the individual terms of their contract. Lastly, FSP members are encouraged to communicate their issues and concerns by emailing the FSP office at email@example.com.
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