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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UHC to remove prior auth for some radiology and cardiology tests.

Starting Jan 1, 2026 certain nuclear imaging tests, OBGYN ultrasounds, and certain cardiology tests will no longer require a prior authorization for some of the  following plan types: 1.UnitedHealthcare Insurance Company2.UnitedHealthcare Mid-Atlantic, inc. 3.UnitedHealthcare Plan of the River Valley, Inc. and 4.UnitedHealthcare Insurance Company of the River Valley5.Oxford Health Insurance, Inc.United Healthcare Level Funded (formerly All…

Anthem BCBS NY: New PET tracer UM policy

The following information will apply to any DOS on 12/1/25 and thereafter. Starting 12/1/25 the PET tracer will require an auth in addition to PET services. Please submit both PET and radiotracer codes- for prior authorization. The UM criteria for PET will not be affected. However both codes will be either approved or denied. Please…

PrEP proper billing and coding

Proper Medical coding and billing is important to the financial health of your practice! Medication codes: Administration code Please avoid using the regular 96372 administration code. Instead use the following administration code: G0012 This code is used when the provider physically administers the PrEP medication. Supply Code For the oral PrEP pharmacies should bill: Q0251…

Posted in Cinga Insurance, Training, Updates

Cigna: Smoking Cessation is covered-Commercial plans

Recently, Cigna began to implement clinical quality Initials that align with NCQA Medical Assistance and Smoking and Tobacco Use Cessation Quality Measure.

As per ACA, smoking cessation is a covered service. Cigna is encouraging the providers to identify, screen and treat for tobacco dependence.

After the Provider will identify the patient, Cigna will reach out to the patient, and encourage them to quit smoking and seek support from their provider.

Which codes to use?

As per Cigna Preventative Care Services Policy: (A004)– these codes can be used with any DX code.


Note: although, Cigna states that these services are covered free of charge to the patient, if the provider performs these services on the same DOS with Preventative EM code then some of these tobacco cessation treatment services could be subject to additional out of pocket costs for your patients. To avoid this, providers are allowed to bill the smoking cessation codes on a separate encounter as preventative services (EM codes).


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Posted in Updates

New Publishing Project: Article Published in AAPC Healthcare Business Monthly Magazine!

I am always excited to read AAPC Healthcare Business Monthly Magazine. However for the Month of November 2021, I extra exited, because my article (see below) was published! Proud of being part of AAPC!

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