|
Multiple Procedure Policy
Policy Statement
When a surgery involves more than one surgical procedure covered under a member's plan, multiple surgery reduction guidelines apply.
Note: State legislation and/or plan-specific language supersede CIGNA HealthCare administrative guidelines.
Reimbursement Policy
Multiple procedures (modifier 51)—procedures performed during the same operative session by the same provider—are reimbursed:
- 100% allowable for major procedure, or first surgical procedure
- 50% allowable for all other procedures
Bilateral procedures (modifier 50)—procedures requiring a separate incision performed during the same operative session—are reimbursed:
- 100% allowable for major procedures, or first surgical procedure
- 50% allowable for all other procedures
Back to top
Exclusions
- This policy may not apply to facility charges.
- This policy does not apply to procedures deemed to be Modifier 51-exempt.
Back to top
Quick Tips
- Assistant surgeon fees will be subject to multiple procedure policy.
- Participating providers cannot balance bill members for charges in excess of CIGNA HealthCare allowable amounts.
- In some cases, the office visit is not separately reimbursable from the surgical code; the office visit copay does not apply.
- Always check "Clean" Claim Requirements before submitting your claim for payment.
|
