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- CAP Calls on Cigna to Rescind Policy to Deny Pay for Professional Component of Clinical Pathology
The CAP strongly urged the health insurer Cigna to rescind a new payment policy to deny claims when the professional component (modifier 26) of clinical pathology is billed. In a letter to Cigna on April 23, the CAP urged Cigna to continue paying for the professional component of clinical pathology services for all pathologists. The CAP further engaged with the presidents of state pathology societies and state issue advisors on the Cigna policy and gathered feedback on how the change will affect pathologists in their states.
Cigna announced the change on April 12 and the denials will take effect July 11. The change would affect pathologists in several states.
The CAP maintains the professional component of clinical pathology (PC of CP) services are critical to the reliable and accurate diagnosis and treatment of patients. For Cigna to discontinue reimbursement for these services will prove detrimental to patients, and to the integrated delivery of care to which laboratory diagnostic services are central.
“The PC of CP services are critical to the reliable and accurate diagnosis and treatment of patients, particularly in delivery systems increasingly reliant upon care coordination, integration, and population management,” the CAP letter said. “The CAP’s Policy on Pathologist Professional Component Billing for Clinical Pathology Services describes the nature and type of professional services provided by the physician director of a clinical laboratory. As set forth in that policy, pathologists as directors of hospital laboratories spend a significant amount of time and effort fulfilling their responsibility for quality laboratory services to their patients and their fellow practitioners.”
The CAP will keep its members informed on this issue as new developments are available.