Posted in Cinga Insurance, Payer Updates, Payers and CPT reinbursement, Training, Updates

Cigna to add more codes to their Virtual Vare Reimbursement Policy and make them permanent, however…

At the beginning of Covid 19 PHE and during, the insurance payers scrambled around to put together virtual care/telehealth/telemedicine policies. Since then, there were many revisions, so it is of no surprise when Cigna announced that they are adding some of the codes that were on non-permanent virtual list to their Virtual Care Reimbursement Policy.


These Codes are:

However, how can home health services like S9123Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when CPT codes 99500-99602 can be used), code that is used for coding and billing Private Duty nursing Billing, be used as a virtual code? This code is used for MLTC members that require around the clock nursing care, members that cannot take care of themselves…so how are the services supposed to be done via “virtual care”?

Just my 2 cents….. 🙂


Would you like to read the full Cinga Virtual Care Reimbursement Policy? Click on this link: https://static.cigna.com/assets/chcp/secure/pdf/resourceLibrary/clinReimPolsModifiers/R31_Virtual_Care.pdf


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Aetna Reimbursement Policy: A9275

According to the Aetna October Provider Updates: Aetna will NO LONGER REIMBURSE for code A9275- Home glucose disposable monitor, includes strips. This DME is considered statutory non-covered by Medicare.

Effective Date: 1/1/2024

This reimbursement policy change applies to commercial and Medicare lines of business (plan types).

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Aetna Commercial and Medicare Plans: Payment for Occupational Therapy/Physical Therapy Assistants

As per Aetna Updates: starting December 1,2023 the Occupational Therapy Assistants and Physical Therapy Assistants will get their own reimbursement for performed services.

Reimbursement amount: 85% of Allowed amount.

Please append the following modifiers to the services that are performed by the PTAs and OTAs:

CO-occupational therapy services performed in part or as a whole by an Occupational Therapy Assistant

CQ-physical therapy services performed in part or as a whole by a Physical Therapy Assistant.

This change applies to Medicare and Commercial plan types.

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