College of American Pathologists




January 9, 2014
© 2014 College of American Pathologists
Special Report
CAP Opposes Cigna Policy to Deny Payment for the PC of Clinical Pathology Services

January 9, 2014—The College of American Pathologists is opposing a new policy by the insurance carrier Cigna that will reject payment for the professional component (PC) of clinical pathology services beginning in March.

The CAP first engaged with Cigna in December, on the same day the insurer notified providers, by stating the College strongly disagreed with the new policy. Cigna has stated, as of March 10, it will no longer pay for claims submitted with the 26 modifier when billed with lab and other codes with CMS designation 3 or 9 indicators. Cigna’s policy would deny payment for several specialties, but pathology and laboratory services disproportionately, which Cigna has acknowledged.

Cigna claims that this change is in line with CMS practices, but the CAP has stated the assertion is patently incorrect. CAP has also called Cigna’s attention to recent legal victories supporting the payment of these services.

More information will be published in STATLINE as it becomes available.


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