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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 HealthcareSM 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 our Clean Claim Requirements before submitting your claim for payment.
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Disclaimer
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.