CMA and representatives of various state medical societies have successfully resolved another RICO settlement dispute involving the payment of add-on codes (claims submitted for additional procedures by the same physician above and beyond the primary procedure). CIGNA has agreed to retroactively pay previously denied claims with add-on codes for computer-aided digital (CAD) mammography originally submitted between January 1 and October 10, 2004.

As you know, CIGNA in early 2004 settled CMA’s civil racketeering (RICO) lawsuit, which alleged that for-profit HMOs used fraud and other illegal activities to interfere in the physician-patient relationship. The case, which became the largest class-action health care lawsuit in U.S. history, allowed physicians to air profound grievances against an industry that had arrogantly and unfairly exploited them and harmed their patients for more than a decade.

In the settlement, CIGNA specifically agreed, among many other things, to pay all add-on codes from the date they became effective under the CPT system. The codes in question (CPT Codes 76082 or 76082 as add-on codes with 76090, 76091, or 76092) became effective January 1, 2004, but CIGNA did not begin paying those claims until October 10, 2004.

Resubmitting claims is simple. Download the claims resubmission spreadsheet from the RICO Resource Center and e-mail the completed spreadsheet to cadmammorebsubmit@CIGNA.com. You may also mail completed spreadsheets to CIGNA R&R Department P&C, P.O. Box 9018, Sherman, TX 75091-9018.

Claims can be resubmitted from June 1 to December 1.

More information is available in the RICO Resource Center.

Contact: CMA’s legal information line, 415/882-5144 or legalinfo@cmanet.org.