Guest guest Posted August 30, 2007 Report Share Posted August 30, 2007 I called Cigna regarding a patient's acupuncture coverage, and (to be brief), they said that the acupuncture procedure codes 97810 & 97811 are covered but required pre-certification for medical necessity (which opens up the possibility of denial). The patient called and they said that this is true, but there are other acupuncture codes that DON'T require precert, and are covered. He wouldn't tell her which ones. Would the acu w/e-stim codes 97813 & 97814 be covered without precert for medical necessity? I find it strange, but then insurance companies do starnge things. Are there other acupuncture procedure codes that I don't know about? Anyone have experience with this? Thanks so much! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2007 Report Share Posted August 30, 2007 CIGNA is your worst nightmare. I’ve had to send a letter of medical necessity with EVERY submission and have still waited up to 2 years for payment. And I’m an in-network provider! Good luck. _____ Chinese Medicine Chinese Medicine On Behalf Of fiammasita Thursday, August 30, 2007 9:55 AM Chinese Medicine Cigna & acceptable codes I called Cigna regarding a patient's acupuncture coverage, and (to be brief), they said that the acupuncture procedure codes 97810 & 97811 are covered but required pre-certification for medical necessity (which opens up the possibility of denial). The patient called and they said that this is true, but there are other acupuncture codes that DON'T require precert, and are covered. He wouldn't tell her which ones. Would the acu w/e-stim codes 97813 & 97814 be covered without precert for medical necessity? I find it strange, but then insurance companies do starnge things. Are there other acupuncture procedure codes that I don't know about? Anyone have experience with this? Thanks so much! Version: 7.5.484 / Virus Database: 269.12.12/979 - Release 8/29/2007 8:21 PM Version: 7.5.484 / Virus Database: 269.12.12/979 - Release 8/29/2007 8:21 PM Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 30, 2007 Report Share Posted August 30, 2007 Hi Barbara, This may vary from state to state, or maybe I just got lucky. I'm in Arizona and have been seeing a CIGNA patient for 9 months with their approval as an out-of-network provider. They authorize a small number of treatments at a time, and each time I have to jump through some hoops for extension of the authorization. Even better, my patient pays me and they reimburse her with the superbills I provide. I do not, however, advertise that I will do this for every patient. It does eat up quite a bit of my time and I don't enjoy the game. Barbara Beale <bbeale wrote: CIGNA is your worst nightmare. I’ve had to send a letter of medical necessity with EVERY submission and have still waited up to 2 years for payment. And I’m an in-network provider! Good luck. _____ Chinese Medicine Chinese Medicine On Behalf Of fiammasita Thursday, August 30, 2007 9:55 AM Chinese Medicine Cigna & acceptable codes I called Cigna regarding a patient's acupuncture coverage, and (to be brief), they said that the acupuncture procedure codes 97810 & 97811 are covered but required pre-certification for medical necessity (which opens up the possibility of denial). The patient called and they said that this is true, but there are other acupuncture codes that DON'T require precert, and are covered. He wouldn't tell her which ones. Would the acu w/e-stim codes 97813 & 97814 be covered without precert for medical necessity? I find it strange, but then insurance companies do starnge things. Are there other acupuncture procedure codes that I don't know about? Anyone have experience with this? Thanks so much! Version: 7.5.484 / Virus Database: 269.12.12/979 - Release 8/29/2007 8:21 PM Version: 7.5.484 / Virus Database: 269.12.12/979 - Release 8/29/2007 8:21 PM Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 31, 2007 Report Share Posted August 31, 2007 Chinese Medicine , " fiammasita " <fiammasita wrote: >Hi Group. This has been my experience with CIGNA for several months but no one told me there were codes to be used that did not required a ltr of medical necessity. And how do you do a letter of medical necessity without first seeing the patient??? Any help would be greatly appreciated. Shawn usually has the latest and best so maybe he/you would reply. Thanks. Reenah McGill > I called Cigna regarding a patient's acupuncture coverage, and (to be brief), they said that the > acupuncture procedure codes 97810 & 97811 are covered but required pre-certification for > medical necessity (which opens up the possibility of denial). The patient called and they said > that this is true, but there are other acupuncture codes that DON'T require precert, and are > covered. He wouldn't tell her which ones. > > Would the acu w/e-stim codes 97813 & 97814 be covered without precert for medical > necessity? I find it strange, but then insurance companies do starnge things. Are there other > acupuncture procedure codes that I don't know about? Anyone have experience with this? > > Thanks so much! > Quote Link to comment Share on other sites More sharing options...
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