Cigna Again Postpones Reduction for PCCP Reimbursement

August 4, 2022

By: Beth Madden, Client Administrator

If you are having trouble keeping up with Cigna’s changes to their policy for the payment of the Professional Component of Clinical Pathology (PCCP), you are not alone. According to a recent letter, it now appears changes to reduce these payments to $5 when the professional/technical component indicator is 3 or 9 are on hold.

Background and moving forward: 

In September of 2021, Cigna announced they would cease paying PCCP. After some pushback from the College of American Pathologists (CAP) and others, Cigna silently retreated from their stance. The following spring, Cigna announced they would reimburse PCCP at $5 per unit beginning July 1, 2022. However, on July 29, Cigna issued another letter stating they were “reevaluating” the policy and will delay implementation. The letter indicates they will issue a new implementation date after an “internal evaluation” is completed.

Cigna’s website cites this delay as “a result of conversations with our provider partners” and says they plan to issue another policy update in the future and notify affected providers. Interestingly, their published policy on this issue lists an update on 8/2/2022 showing an effective date of 7/1/22 for “codes incorrectly appended with modifier 26 but determined to be reimbursable at market value per service code.” It appears that Cigna is as confused about their policy on PCCP as the rest of us. 

We reached out to Dr. Julie Kessell, Cigna’s Medical Officer for Coverage Policy, but were told she is not accessible. We are now awaiting a call from Cigna’s Medical Policy Department to confirm this news.

If Cigna is not covering PCCP for your practice and you would like to discuss revenue strategy moving forward, feel free to contact us today to schedule a free consultation.

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