Major insurer implements new payment policy for APPs, including those working under physicians

Cigna is implementing a new commercial payment policy for advanced practice providers (APPs). The company will pay APPs for eligible non-surgical services reported directly by an APP using the APP’s national provider identifier (NPI). When services are provided by APPs who do not have an NPI (or are ineligible to bill directly), they should be reported on the APP's behalf by a supervising physician using modifier SA and the physician’s NPI. Cigna will pay for eligible services rendered by an APP and submitted with modifier SA at 85% (or other allowed amount) of the supervising physician’s fee schedule. Prior to this policy, Cigna did not require the use of modifier SA and the APP could bill under the supervising physician and receive the full contracted payment amount.

The policy took effect in most states on Feb. 1 and will expand to Arkansas, Colorado, Kentucky, Ohio, and Texas on March 1. At that point, the only state where it will not apply is Oregon, due to state regulations.

A list of providers who fall under Cigna’s definition is available online, along with more information about the new policy, which is labeled “Reimbursement Policy Number R37.” If you have further questions about the policy, you can call Cigna customer service at 1-800-997-1654 or contact your Cigna provider relations representative. 

— Brennan Cantrell, commercial health insurance strategist, American Academy of Family Physicians

Posted on Feb. 8, 2021, by Brennan Cantrell