Cigna clarifies new PC/CP policy in letter to CAP

December 1, 2021

Pathologists providing the professional component of clinical pathology (PC of CP) services now have additional clarity on how to request reimbursement under Cigna’s new PC of CP policy after the insurer recently provided more details on the policy in a letter to the College of American Pathologists (CAP).

In a November 12 letter to the CAP, Cigna explained that individual pathologists should submit claims for the PC of CP, and if “the facility … has already received payment for the service through their contract with Cigna,” they will be notified in the form of a denial through Cigna’s claim system. At that point, the pathologist should communicate with their facility to determine whether payment for these services were in fact received from Cigna by the facility and, if the denial was made in error, then “this denial carries with it a right to appeal.”

After holding off on the move during the summer amid significant pushback from pathology and lab advocates, Cigna again moved to end reimbursement for the professional component of clinical pathology (PC/CP) beginning Oct. 27, 2021, although the exact cutoff date has varied by state.

However, following the initial news that this policy would move forward again, Cigna attempted to calm fears by saying this change was less broad than its initial summer proposal, and would only result in denials “when the facility where the services were provided is contractually responsible for laboratory management and oversight services.”

For those with questions about billing PC of CP, CAP has compiled an information package detailing best practices. You must be a CAP member to access the guide.

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