When should modifier 33 be used?
If you provide multiple preventive medical services to the same non-Medicare patient on the same day, append modifier 33 to the codes describing each preventive service rendered on that day. You may also apply modifier 33 when a preventive service must be converted to a therapeutic service.
Does Cigna follow CMS guidelines?
Cigna-HealthSpring currently accepts the revised CMS 1500 Health Insurance Claim form (version 02/12). Claims sent electronically must abide by the standards adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Does Cigna Cover prophylaxis?
The majority of Cigna plans fall under the PPACA, and cover the full cost of preventive care services, including copay and coinsurance.
Does Cigna cover preventive colonoscopy?
In order for Cigna to pay this service accurately as a preventive service, with no cost share required by your patient, the diagnosis and procedure codes submitted on the claim must represent a screening colonoscopy, as indicated on page seven of the following coding table.
What does modifier 33 stand for?
Preventive Services
Modifier 33 is a CPT modifier used to identify medical care whose primary purpose is delivery of an evidence based service, based on recommendations from the US Preventive Services Task Force.
How does modifier 33 affect reimbursement?
Modifier 33 helps the insurance company to quickly identify the service as preventive and apply the proper benefit and payment to the claim but without it, the claim can be processed incorrectly causing the patient to incur cost for a service that should be paid in full by the insurance company.
Does Cigna healthspring require referrals 2021?
Not covered. Authorization rules may apply. Referral is required. You pay a copayment of $20 for each Medicare-covered acupuncture visit.
How do you know which Cigna plan I have?
Call Cigna at the number on the back of your ID card, or. Check www.mycigna.com, under “View Medical Benefit Details”
Is Truvada covered by Cigna?
II. Truvada (emtricitabine/tenofovir disoproxil fumarate) is covered as medically necessary when BOTH of the following are met: a.
How do I check my Cigna benefits?
At what age does Cigna cover colonoscopy?
Mammogram (1 per calendar year, usually after the age of 40): Routine X-rays of breast tissue to check for any signs of cancer or other abnormalities. Some health plans may also cover costs for 3D imaging. Colonoscopy (typically 1 per every 10 years, usually after the age of 50): Screening for colon cancer.
Is an MRI considered preventive care?
For today’s preventative screenings, most doctors recommend choosing MRI. Many patients benefit from early cancer detection, which can be accomplished with MR, without the danger of ionizing radiation. The speed, accuracy, and detail provided by this screen comes at no risk to the patient’s health.
What does modifier 33 mean on a CPT code?
Modifier 33 is applicable to CPT codes representing preventive care services. CPT codes not appended with modifier 33 will process under the member’s medical or preventive benefits, based on the diagnosis and CPT codes submitted. Modifier 33 should be appended to codes represented for services described in the US
Which is the correct colonoscopy modifier for Cigna?
But for other commercial carriers (e.g., Cigna), we append modifier 33 to the appropriate CPT® colonoscopy code for screening and surveillance colonoscopies that result in therapeutic procedures.
Which is the correct colonoscopy modifier PT or 33?
In our coding department, any patient undergoing a colonoscopy for screening or surveillance with no current symptoms gets either modifier PT Colorectal cancer screening test; converted to diagnostic test or other procedure or modifier 33 Preventive services appended, depending on the payer.
What kind of preventive care does Cigna cover?
Most Cigna plans cover the full cost of preventive care services for individuals with Cigna coverage, including copay and coinsurance. Typically, these services must be provided by in-network health care professionals. There are some exceptions.