Cigna again moves to end PC clinical pathology payments

October 4, 2021

After holding off on the move during the summer amid significant pushback from pathology and lab advocates, Cigna appears to again be moving forward with its plan to end reimbursement for the professional component of clinical pathology (PC/CP) beginning Oct. 27, 2021, although the exact cutoff date will vary by state.

In a late-September letter to providers, the payer states it will, “…Deny separate reimbursement for CPT codes billed with modifier 26 for the professional component of laboratory testing when the CMS National Physician Fee Schedule does not recognize the existence of a professional component for the code and when the facility where the service is provided is contractually responsible for laboratory management and oversight services.”

The letter states this move will align Cigna with CMS policy. The update will take effect for claims processed after the following dates:

Illinois: November 1, 2022
California, Minnesota, and Nevada: November 11, 2021
Delaware, Massachusetts, Maine, North Carolina, New Hampshire, Puerto Rico, Rhode Island, Tennessee, Virginia, Vermont, and Washington: November 26, 2021
Arkansas, Colorado, Kentucky, Ohio, and Texas: December 26,2021
All other states: October 27, 2021

On Oct. 5, the College of American Pathologists (CAP) weighed in on the issue via the following statement:

“The CAP is analyzing the latest communications from Cigna to determine its exact effect on pathologists practicing in a variety of settings. The CAP has contacted Cigna officials to get additional information and discuss concerns pathologists have with the policy.”

You may view the full letter from Cigna below.

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