Cigna has recently released a new therapy policy update imposing a four-unit per visit limitation AND a 15% payment reduction for services provided by OTAs and PTAs. These changes will be effective October 15th for most states, with TX, KY, CO, and OH starting on November 1st.  I have attached a template notice that Cigna sent out to providers. AOTA and APTA have been collaborating on advocacy efforts with Cigna.

For the 4 unit per visit limit, please be aware that if billing more than four units, Cigna will pay the units as listed on the claim, i.e., the first four units will be the four they will pay. Cigna informed AOTA and APTA that it cannot sort units by dollar amount. Thus, the onus is on the therapist to list the procedures in descending dollar order.

Cigna has also indicated that there will be an exception to the four-unit limit under limited circumstances. The national associations have requested additional guidance from Cigna regarding the exceptions process for the four-unit limitation and will share when provided

We expected to hear back from Cigna on possible mitigation for the 15% OTA/PTA payment cut soon after Labor Day. While Cigna has indicated as recently as Friday, September 23rd, that a response is forthcoming and the policy team is working on it, we have not received an update. As we are now w/in 30 days of the October 15th implementation, we are asking providers to tell Cigna how the OTA/PTA differential will impact their practices and clients and ensure their voice is heard.

Providerscan write a letter to Cigna addressing how this new policy will affect their clinic setting and their ability to deliver care to Cigna beneficiaries. For the greatest impact, providers should customize the letter and add specific examples from their practice. I have included a template letter for this purpose, but practitioners must remove all template language before sending it.

Some other steps that can be taken:

  1. Patients can send a letter to Cigna -  Encourage patients that are Cigna beneficiaries to write letters expressing their concern on how this policy will adversely impact their care. Please encourage the patient or guardian to customize the letter and to share their personal experience.   
  2. Patients can speak to the HR department of their employer - Providers can suggest they call the HR (human resource) department to inform them of their concern about potentially losing access to OTA/OT team services.
  3. Talk to your legislator. While legislative action may not be possible at this time, providers can still notify legislators and make them aware of this Cigna policy change and how it will impact enrollees, the delivery of occupational therapy services, and the other adverse downstream effects. The sooner they hear about it and the greater the frequency, the more likely they will explore action to challenge the policy.
The collective strength of our members does matter if we all advocate for our profession and the health of the patients we serve. Please encourage any non-member colleagues to act and ask that they consider membership as there is strength in numbers.