CIGNA fixes excimer laser prior authorization process
Ask the Expert
By Apoorva Stull, Senior Manager, Advocacy Communications, June 1, 2024
DermWorld talks to Mollie MacCormack, MD, FAAD, chair of the Academy’s Patient Access and Payer Relations Committee about the AADA’s role in advocating that CIGNA update its process for how excimer laser prior authorization approvals are entered into their system.
DermWorld: Tell us why payer advocacy is so critical for AADA members?
DermWorld: What was AADA’s role in getting CIGNA to update its process for how excimer laser prior authorization (PA) approvals are entered into their system?
Dr. MacCormack: Individual dermatologists contacted the Academy’s Patient Access and Payer Relationships Committee reporting unexpected denials of 96920 even when appropriate prior authorization had been obtained. Interestingly, the higher valued 96922 code was being paid in full. Through communication with Cigna, a technical glitch was identified which obscured the PA for the lower valued code when a PA for 96921 or 96922 had also been obtained. Due to AADA advocacy, a systems fix was enacted allowing all excimer laser codes to be processed correctly.
DermWorld: How will the new CIGNA process eliminate inappropriate claim denials for the laser excimer CPT codes (96920, 92921, 96922) and alleviate burdens on dermatology practices?
Dr. MacCormack: Dermatologists should no longer see inappropriate denials for the excimer laser codes. As readers are likely aware, the excimer laser codes were redefined by CMS as of Jan. 1, 2024. Cigna has not altered covered diagnoses as of now. We will continue to monitor for any policy changes.
DermWorld: What is the true impact for dermatologists with this process change with CIGNA?
Dr. MacCormack: Due to the change, dermatologists should no longer receive claims denials indicating a lack of pre-approval when approval is obtained for this service.
Mollie MacCormack, MD, FAAD, serves as chair of the Academy’s Patient Access and Payer Relations Committee.
