Facsimile Transmission Cover Sheet 3 Cigna. DATE. 2821/10/07 04:58:90 FAX# 19549670109 FROM = Cigna SUBJECT: attn hector TOTAL NUMBER OF PAGES (INCLUDING THIS PAGE]: 4 _yé Cigna. CONFIDENTIALITY NOTICE: This facsimile message, including any attachments, is for the sole use of the intended recipient and may contain confidential and privileged information. Any unauthorized review, Use, disclosure or distribution is prohibited. If you are not the intended recipient, please notify the sender at the email address noted above and destroy all copies of the message, along with any attachments.Cigna ite Bic: is = PB bet vo “Yyé Cigna. cog, N02 September 29, 2021 Cardiovascular Consultants PA Attn: Carlos Loayza 7421 N University Dr Suite 112 Tamarac FL 33321-2952 RE: Patient/Member Name: Debra Peasley ID #: U40855782 Service: 99211 Dos: 9/7/2021 Dear Cardiovascular Consultants PA, Your request for a Single Level Provider Payment Appeal for the service referenced above has been completed. After reviewing your request, we have decided to uphold the original decision. This charge for CPT code 99211 billed with modifier 25 is denied since modifier 25 is, inappropriate for this Evaluation and Management code according to CPT guidelines. Please refer to Cigna.com and the Healthcare Professional site for further information on our claim bundling policies. It will allow you to enter in specific procedure codes to determine how and why a claim will edit these procedure codes. See: hittp:// www.cigna.com/customer_care/healthcare_professional/medical/claim_editing htm! This is the final internal level of appeal. As a reminder, do not bill Debra Peasiey for these services. Please refer to the explanation of payment regarding financial responsibility. If you are not satisfied with the decision, please refer to the dispute resolution sections of your Provider Contract and/or Program Requirements with us. Requests for alternate ‘All Cigna products and services are provided exclusively by or through such operating subsidiaries and not by Cigna Corporation. Such operating subsiiaris include Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Evert Behavioral Heath, Inc, Evemorth Care Solufons, inc, Evemorh Direct Health, LLC, Cigna Heath Management, nc, subsiaries of eviCore 1, LLC and HMO ar service company subsidiaries of Cigna Health Corgoration and Cigna Dental Heath, Inc. Please refer to your ID card forthe subsicary that insures or amirstes your benefit plan. Cigna Health Management Inc. and Evemrth Behavioral Heath, ne, Evemorh Care Solutions, inc., Evernorth Direct Health, LLC, nc are licensed or certified utization review ents. The Cigna name, logo, and other Cigna marks ae owned by Cigna intellectual Property nedispute resolution must be submitted within one (1) year from the date of this letter, subject to applicable law and your provider agreement. If you have any questions, please feel free to call Cigna at 1-800-882-4462. A representative will be happy to assist you. Sincerely, Robert B, Appeal Processor