Cigna authorization policy change 2016?

Does anyone know if Cigna now requires pre-authorization for arthroscopies? I have had several surgeries deny for this reason, and the surgical scheduler did not CHECK to see if she needed auth or not! I am in South Carolina. Does anyone have a link?

Comments

  • edited May 2017
    Hi,
    For state of Iowa they do.
    Patty
  • edited May 2017
    Cigna now has a musculoskeletal preauthorization policy in place (since 1/1/16) and there are many codes now that have to be preauthorized, and yes, arthroscopies of knee, hip, shoulder must be preauth'd. If you go to their website you should be able to pull of the new policy and it lists the specific CPT codes. It's called "Musculoskeletal Program Policy Updates". Also, they do not allow retro-auths, so the codes you have pre-auth'd are the only ones they will pay. When I found it, I just googled Cigna policy on musculoskeletal surgeries and it came right up. Good Luck. FYI, United Healthcare also instituted a similar policy effective 4/4/16.

    Sandi Hamrick, CPC
    Toledo Orthopaedic Surgeons
  • Thank you so much guys! By the time I get the info they have already done the surgery. It is an uphill battle! Thanks
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