News and Updates from Private Payers

Submitting Claims to Cigna with Modifiers 25 and 59

Effective April 27, 2009, Cigna will require providers to submit supporting documentation for some claims containing Modifiers 25 and 59. Visit Cigna to view an updated list of affected CPT codes >Log in and click on Resources > Claim Editing Procedures

Cigna Coding Guideline for Modifiers 25 and 59

Cigna-List of Affected CPT Codes

Academy Comments on Medical Policies (2009)

The Academy has offered comments to various private insurers on the following medical policies:

• Nasal Surgery to treat Obstructive Sleep Apnea- Empire Blue Cross Blue Shield and WellPoint
• Mandibular Segmental Osteotomy with Genioglossus Advancement- WPS
• Bundling CPT codes 31240 and 31255- Anthem Blue Cross
• Radiofrequency Ablation of the Tongue – Highmark Blue Cross Blue Shield
• Sinus Balloon Catheterization- United Healthcare

For more details, contact Healthpolicy@entnet.org

Anthem BCBS updates its medical policy for Bone Anchored Hearing Aids (SURG 00020)

Based on the input of the Academy’s Implantable Hearing Devices Subcommittee, as well as suggestions from an academic medical center, Anthem BCBS decided to revise its medical policy to include BAHA® Intenso™ hearing aids in its coverage criteria. The medical policy became effective January 14, 2009. To view the policy visit and for more information on our comments contact our health policy department at 703/535-3727.

Drug Protocol for Obtaining Botulinum Toxin Type A (Botox) and Type B (Myobloc)

Effective May 1, 2009, all UHC contracted physicians and other health care professionals will be required to obtain Botox ® and Myobloc ® from the insurer’s participating specialty pharmacies to guarantee coverage for these medications. You can obtain a list of participating pharmacies by visiting www.UnitedHealthcare.com, Tools and Resources > Policies and Protocols >Protocols

Blue Cross Blue Shield (BCBS) Settlement Agreement Coding Provisions are now in Effect

Several coding provisions of the BCBS Settlement Agreement became effective on Jan. 21, 2009. The settling Blue Plans are required to follow most Current Procedural Terminology (CPT®) codes, guidelines and conventions, including:

• Recognition of CPT-designated “Add-on” codes, CPT modifiers 25 and 59, CPT supervision and interpretation codes.
• No global period for surgical procedures will be longer than the period designated by CMS.
• Blue Parties shall not automatically change a CPT code to one reflecting a reduced intensity of service.

Provisions already in effect include: no initiation of overpayment recovery efforts more than 18 months (or less based on State law) after the original payment; 90 days’ advance notice of material adverse changes; and acceptance of the settlement’s specified definition of medical necessity. For more, visit the AMA website