General Category > General Questions

Independent Review- Assistance needed (original issue in the 'No Preauth' thread

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rballinger1:
I reviewed Cigna's Medical Policy on substitute tissue.  The medical policy appearing on their website "specifically" states that the AmnioBand is considered "investigational for all purposes and not covered by Cigna.  If the customer service representative gave the provider an authorization, the provider's office is responsible for verifying if the product being used is classifi3ed as experimental in itself, or for the diagnosis being used.  When you read Cigna's policy it is not covered under any circumstance.  Your best hope is the sales representative providing you material to share with the AG, but I think it will end up being the provider's responsibility if he/she is contracted, unless the provider had the patient sign an advance notice that he/she would be responsible for any non-covered services/items.


CIGNA'S WEBSITE (https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0068_coveragepositioncriteria_woundhealing.pdf#search=Q4151)

Cigna does not cover ANY of the following products because each is considered experimental, investigational, or unproven for ANY indication (this list may not be all-inclusive):   Skin Substitute Reason(s) for Request (this list may not be all inclusive)

Application CPT/HCPCS Codes Product HCPCS Codes
ActiveBarrier® Wound care 15271-15278 C5271-C5278
Q4100 C9399
ActiveMatrix® flowable Connective tissue repair No specific code
Q4100 C9399
Acuseal Cardiovascular Patch Cardiovascular reconstruction No specific code
C1768
Adherus Dural Sealant® Dural repair  No specific code
Q4100 C9399
Affinity Wound care 15271-15278
 
Q4159
Allopatch HD™  Tendon augmentation No specific code
Q4128
AlloSkin™ Wound care 15271-15278 C5271-C5278
Q4115 Q4141
AlloSkin™ RT Wound care 15271-15278
 
Q4123
Allowrap™ Wound care
 
15271-15278 Q4150
AmnioBand/Guardian Wound care 15271-15278
 
Q4151
AmnioBand® Particulate Wound Care 15271-15278 C5271-C5278
Q4168
AmnioCare

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