College of American Pathologists




February 6, 2014
© 2014 College of American Pathologists
Special Report
Cigna Delays Professional Component of Clinical Pathology Policy

February 6, 2014—The private insurer Cigna has postponed its payment policy to deny the professional component (PC) of clinical pathology (CP) services.

Cigna has not withdrawn the payment policy altogether, but the national insurer will not proceed with implementing it on March 10, following opposition from the College of American Pathologists (CAP) and others. While Cigna reevaluates the policy, the CAP has offered to serve as an ongoing resource for information.

“The proposed payment policy could be detrimental to Cigna’s existing relationships with pathologists, hospitals, and others, including Cigna’s beneficiaries,” said CAP President Gene N. Herbek, MD, FCAP. “These relationships are critical to increasing care coordination, managing health populations, and providing patients with high quality services. The CAP will continue to work, on behalf of its members, with Cigna to bring about resolution to the ongoing provision of and compensation for these medically necessary services.”

In December, Cigna notified pathologists and laboratories that claims submitted with modifier 26 for the PC of CP would no longer be paid beginning March 10. The CAP immediately initiated a series of exchanges with Cigna on the national level, including a January 10 letter from Dr. Herbek. The CAP also served as a reliable resource for information, including why the PC of a CP service is a valuable and compensable medical service. On February 5, the CAP received notice from Cigna that it would not move forward with the policy after receiving feedback from the College and state and local pathology organizations.

Cigna stated it will continue to consider the feedback it received. The insurer will send additional information after an internal evaluation is complete.

The CAP will continue to update members about this issue and its other advocacy work in future editions of STATLINE.


202-354-7118  •  202-354-8101 (fax)  •  800-392-9994


Related Links