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Coverage and Claims
Medical Supplies Coverage Policy
Understand when consumable medical supplies are covered, and what is considered a consumable medical supply.
What is a Consumable Medical Supply?
Consumable medical supplies are non-durable medical supplies that:
- Are usually disposable in nature
- Cannot withstand repeated use by more than one individual
- Are primarily and customarily used to serve a medical purpose
- Generally are not useful to a person in the absence of illness or injury
- May be ordered and/or prescribed by a physician.
Plan Exclusions: Most plans contain exclusions for consumable medical supplies. Although plan language varies considerably, a typical exclusion defines consumable medical supplies as including, but not limited to, bandages and other disposable medical supplies, skin preparations and test strips.
When does Cigna Healthcare allow coverage for Consumable Medical Supplies?
Consumable medical supplies are covered under our coverage policies in conjunction with:
- Inpatient hospital services
- Outpatient hospital facility services
- Home health services
- Diabetic services
- Breast reconstruction and breast prostheses
Additional Managed Care Guidelines:
- Consumable medical supplies can be allowed under the lead referral/precertification for the associated services.
- Ostomy supplies are covered.
- If consumable medical supplies are not provided in conjunction with authorized or referred services, and are not covered under the plan for benefits, they will not be reimbursed by Cigna HealthcareSM.
Note: State or federal legislation and/or plan-specific language supersede the administrative coverage policies of Cigna Healthcare.
How do Health Care Providers get Reimbursed?
Reimbursement guidelines vary, dependent on the type of medical supply, however all consumable medical supplies should be billed using the applicable HCPCS codes.
- Casting & Splint Supplies (Q4001-Q4051) are payable in addition to other services billed on the claim.
- Consumable medical supplies provided in conjunction with Durable Medical Equipment (DME) are covered if the supplies are necessary for the function of the equipment and the equipment is covered under the plan.
- Diabetic Supplies
- Claims for insulin needles and syringes (A4206, A4207, A4208, A4209, A4215) will be paid under the customer's benefit plan, either medical or pharmacy.
- Claims for lancets (A4258 and A4259) will be denied as consumable supplies, unless covered under state mandate or pharmacy rider.
- Claims for glucose test strips (A4772, A4253) will be denied as consumable supplies, unless covered under state mandate or pharmacy rider.
- Claims for glucometer devices (E0607, E0609) will be paid under the DME benefit.
- Surgical Trays are considered reimbursable for select procedures. For more information, please log in to the CignaforHCP portal.
- Oxygen and Oxygen Delivery Systems/Supplies are not considered consumable supplies or DME. They are only reimbursed if covered under a customer's medical benefit.
- Breast Reconstruction and Prostheses are covered under the EPA benefit. Mastectomy bras are covered following a mastectomy under a customer's medical benefit.
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Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of The Cigna Group Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (“LINA”) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. The Cigna Healthcare name, logo, and other Cigna Healthcare marks are owned by The Cigna Group Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna Healthcare.
All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna Healthcare sales representative. This website is not intended for residents of New Mexico.