Important Cigna and UHC Updates

Healthcare providers are familiar with periodic policy updates from the Centers for Medicare and Medicaid Services (CMS) but private health plans are increasingly developing their own rules. That trend requires ongoing diligence to identify and monitor changes related to documentation and reimbursement, since failure to do so can result in a negative revenue impact for pathology practices. 


Cigna implemented a new Medically Unlikely Edit (MUE) policy effective December 21, 2023.  The rules apply frequency limitations, as defined by CMS, for a range of CPT codes, including those for COVID-19 laboratory services. 

Cigna’s announcement of the policy stated it is “guided by comprehensive criteria such as clinical judgment, anatomic considerations and code descriptors” and involves claims submitted on CMS 1500 claim forms as well as outpatient services reported on UB-04 claim forms.     

United Healthcare (UHC)

The January 2024 UHC Reimbursement Policy Update Bulletin announced implementation of the Molecular Pathology Policy, Professional and Facility for dates of service on or after April 1, 2024.  That policy was originally announced on May 1, 2023 but delayed in September 2023 to allow additional time for providers to complete molecular pathology test registrations for Z-codes on tests. 

The policy requires submission of a DEX-Z code® for molecular pathology claims to be considered for reimbursement.  The codes can be obtained from the Palmetto DEX Registry at and claims will be denied if that information is missing, invalid or doesn’t match the service represented by the CPT code reported on the claim.    

This educational guide was prepared as a tool to provide education for documentation and coding. It is not intended to affect clinical treatment patterns. The material provided is for informational purposes only. Efforts have been made to ensure the information within this document was accurate on the date of distribution. Reimbursement policies vary from insurer to insurer and the policies of the same payer may vary within different U.S. regions. All policies should be verified to ensure compliance. CPT® codes, descriptions and other data are copyright of the American Medical Association (or such other date of publication of CPT®).All Rights Reserved. CPT® is a registered trademark of the American Medical Association. Proprietary and confidential document.  All rights reserved. No part of this document may be reproduced or used in any manner without the written permission of MSN Healthcare Solutions, LLC.

Share this post:

Related Posts
Choices in Radiology Practice Management


Managing a radiology practice isn’t a job for the faint of heart but you get to choose your response to daily challenges, large and small. An ethical foundation with a focus on financial viability can lead to success, longevity and job satisfaction.

Read More
radiologists in hospital setting having discussion over images

Radiology and the Hospital Stipend

Hospital-based radiology groups face a crisis on several levels, from maintaining adequate staffing to managing crushing workloads. Learn how forging a partnership with their hospitals has helped.

Read More

MSN Services Inquiry

If you would like to learn more about MSN services for your practice, please call us or use the form below.

1-866-567-7405  / Local: 706-653-8150

Interested Services:

MSN Email Sign Up

Proactive communication and education are essential to running efficient and profitable practices.

Sign up below to receive regular industry news!