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.