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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HealthFirst: new vision insurance payer

HealthFirst members will no longer have coverage through Davis Vision and Superior Vision effective 1/1/24.


Optometry and Ophthalmology specialists that perform routine vision services and medical optometry services for HealthFirst members will now need to get contracted with the new vision insurance payer: EyeMed.


Starting 1/1/24, EyeMed will handle network management, prior authorization process, member and provider services, as well as claim payments for all routine services and medical optometry services (HealthFirst members)


Providers please contact EyeMed at EyeMedInFocus.com/Join to start the xontracting process.


Below please see the list (not all inclusive) of services that require prior authorization.

Not all inclusive

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Posted in #reimbursement, BCBS Empire NY, NY Providers, Updates

Empire BCBS NY: Pharmacy Reimbursement Policy update 1/1/24

According to the announcement by Empire BCBS for the state of NY- the payer added a new INFORMATIONAL modifier to represent the unused drug when the provider uses a single vial of medication/biologic. This policy applies to commercial Plan types.


Reimbursement Policy Number: C-11031. https://www.empireblue.com/docs/public/inline/C-18001_NY.pdf

Although the effective date of the policy is 6/17/23 the policy will only apply to the drugs/biologics that are administered to the member for DOS 1/1/24 and thereafter


JW modifier is not permitted when the actual dose of a covered drug/biologic administered from a single dose vial is less than the billing unit, as indicated in the HCPCS code description.


When administering medication/biologic, the provider needs to be conscious of what amount of medication the patient needs for their treatment. For example, if the provider requires 20 units and the medication/biologic drug comes in a 10 or 50 mil vial, then the provider should use the 2 10 mil vials to administer the needed dosage instead of using the 50 mil vial and appending the JW modifier to the unused portion of the medication/biologics.


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