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2009 Archival Library
CIGNA
 
Effective April 27, 2009    
     
CPT® Code Combinations with Modifier 25 That Require Documentation Submitted with the Claim

The documentation submitted must establish that the patient's condition required a significant, separately identifiable Evaluation and Management (E/M) service above and beyond the other service(s) provided. The documentation for the E/M service must meet the key components (i.e., history, examination and medical decision making) of that level of E/M service.
You can continue to submit claims electronically to CIGNA, even if supporting documentation is required.  Indicate in box 19/Loop 2300 of the electronic claim that the documentation will be sent through another channel.  The indicators on the electronic claim include the delivery method for sending the attachment (i.e., fax, mail), as well as the description code for the type of attachment (i.e., physicians’ report, operative notes).  Supporting documentation can be faxed to CIGNA at 1.570.496.2945 or sent via mail to the CIGNA address on the back of the patient’s ID card.
       
Code Allowed Description Code Disallowed Description
95004 Percut allergy skin tests 99205 Office/outpatient visit, new
95004 Percut allergy skin tests 99214 Office/outpatient visit, est
95004 Percut allergy skin tests 99215 Office/outpatient visit, est
95004 Percut allergy skin tests 99245 Office consultation
95010 Percut allergy titrate test 99205 Office/outpatient visit, new
95010 Percut allergy titrate test 99214 Office/outpatient visit, est
95010 Percut allergy titrate test 99215 Office/outpatient visit, est
95010 Percut allergy titrate test 99245 Office consultation
95012 Exhaled nitric oxide meas 99214 Office/outpatient visit, est
95012 Exhaled nitric oxide meas 99215 Office/outpatient visit, est
95012 Exhaled nitric oxide meas 99245 Office consultation
95015 Id allergy titrate-drug/bug 99205 Office/outpatient visit, new
95015 Id allergy titrate-drug/bug 99214 Office/outpatient visit, est
95015 Id allergy titrate-drug/bug 99215 Office/outpatient visit, est
95015 Id allergy titrate-drug/bug 99245 Office consultation
95024 Id allergy test, drug/bug 99205 Office/outpatient visit, new
95024 Id allergy test, drug/bug 99214 Office/outpatient visit, est
95024 Id allergy test, drug/bug 99215 Office/outpatient visit, est
95024 Id allergy test, drug/bug 99245 Office consultation
95027 Id allergy titrate-airborne 99214 Office/outpatient visit, est
95027 Id allergy titrate-airborne 99215 Office/outpatient visit, est
95027 Id allergy titrate-airborne 99245 Office consultation
95028 Id allergy test-delayed type 99205 Office/outpatient visit, new
95028 Id allergy test-delayed type 99214 Office/outpatient visit, est
95028 Id allergy test-delayed type 99215 Office/outpatient visit, est
95044 Allergy patch tests 99214 Office/outpatient visit, est
95044 Allergy patch tests 99215 Office/outpatient visit, est
95044 Allergy patch tests 99245 Office consultation
95060 Eye allergy tests 99205 Office/outpatient visit, new
95060 Eye allergy tests 99214 Office/outpatient visit, est
95070 Bronchial allergy tests 99205 Office/outpatient visit, new
95070 Bronchial allergy tests 99214 Office/outpatient visit, est
95070 Bronchial allergy tests 99215 Office/outpatient visit, est
95070 Bronchial allergy tests 99245 Office consultation
95075 Ingestion challenge test 99214 Office/outpatient visit, est
95075 Ingestion challenge test 99215 Office/outpatient visit, est
95075 Ingestion challenge test 99245 Office consultation
96401 Chemo, anti-neopl, sq/im 99215 Office/outpatient visit, est
96402 Chemo hormon antineopl sq/im 99215 Office/outpatient visit, est
96409 Chemo, iv push, sngl drug 99215 Office/outpatient visit, est
96413 Chemo, iv infusion, 1 hr 99215 Office/outpatient visit, est
96416 Chemo prolong infuse w/pump 99215 Office/outpatient visit, est
96521 Refill/maint, portable pump 99215 Office/outpatient visit, est
96522 Refill/maint pump/resvr syst 99215 Office/outpatient visit, est
98925 Osteopathic manipulation 99205 Office/outpatient visit, new
98925 Osteopathic manipulation 99214 Office/outpatient visit, est
98925 Osteopathic manipulation 99215 Office/outpatient visit, est
98925 Osteopathic manipulation 99245 Office consultation
98926 Osteopathic manipulation 99205 Office/outpatient visit, new
98926 Osteopathic manipulation 99214 Office/outpatient visit, est
98926 Osteopathic manipulation 99215 Office/outpatient visit, est
98926 Osteopathic manipulation 99245 Office consultation
98927 Osteopathic manipulation 99205 Office/outpatient visit, new
98927 Osteopathic manipulation 99214 Office/outpatient visit, est
98927 Osteopathic manipulation 99215 Office/outpatient visit, est
98928 Osteopathic manipulation 99205 Office/outpatient visit, new
98928 Osteopathic manipulation 99214 Office/outpatient visit, est
98928 Osteopathic manipulation 99215 Office/outpatient visit, est
98929 Osteopathic manipulation 99205 Office/outpatient visit, new
98929 Osteopathic manipulation 99215 Office/outpatient visit, est
98940 Chiropractic manipulation 99205 Office/outpatient visit, new
98940 Chiropractic manipulation 99214 Office/outpatient visit, est
98940 Chiropractic manipulation 99215 Office/outpatient visit, est
98941 Chiropractic manipulation 99205 Office/outpatient visit, new
98941 Chiropractic manipulation 99214 Office/outpatient visit, est
98941 Chiropractic manipulation 99215 Office/outpatient visit, est
98942 Chiropractic manipulation 99205 Office/outpatient visit, new
98942 Chiropractic manipulation 99214 Office/outpatient visit, est
98942 Chiropractic manipulation 99215 Office/outpatient visit, est
98942 Chiropractic manipulation 99245 Office consultation
98943 Chiropractic manipulation 99205 Office/outpatient visit, new
98943 Chiropractic manipulation 99214 Office/outpatient visit, est
98943 Chiropractic manipulation 99215 Office/outpatient visit, est
98943 Chiropractic manipulation 99245 Office consultation
       
Current Procedural Terminology (CPT®) ©2008 American Medical Association: Chicago, IL.
 


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