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Home Providers Coverage and Claims Access Coverage PoliciesCoverage for Multiple Surgical Procedures

Coverage for Multiple Surgical Procedures

When a surgery involves more than one surgical procedure covered under a customer's plan, reimbursement policies apply.

Reimbursement Policy

Multiple Procedures

Procedures performed during the same operative session by the same provider (known as "multiple procedures") are reimbursed following these guidelines:

  • 100% allowable for major procedure, or first surgical procedure
  • 50% allowable for all other procedures

Bilateral Procedures

Procedures requiring a separate incision performed during the same operative session (known as "bilateral procedures") are reimbursed following these guidelines:

  • 100% allowable for major procedures, or first surgical procedure
  • 50% allowable for all other procedures

Exclusions

  • This policy may not apply to facility charges.
  • This policy does not apply to procedures deemed to be Modifier 51-exempt. A Modifier-51 is used to indicate the subsequent surgeries/procedure(s) that are performed during a single session.

Quick Tips

  • Assistant surgeon fees are also subject to multiple procedure policy. Participating providers cannot balance bill customers for charges in excess of Cigna 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 Cigna's Clean Claim Requirements before submitting your claim for payment.

Related Documents

Coverage Policies on CignaforHCP Preventive Care Services – (A004) Administrative Policy [PDF]

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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., and Cigna HealthCare of North Carolina, 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 Cigna 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 name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna.

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