Cost-share will be waived for COVID-19 related services only when providers bill the appropriate ICD-10 code and modifier CS. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. No. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with the CMS reimbursement rates noted below to ensure timely, consistent and reasonable reimbursement. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. No. No. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. Cigna waived cost-share for COVID-19 related treatment, in both inpatient and outpatient settings, through February 15, 2021 dates of service. Services not related to COVID-19 will have standard customer cost-share. The following Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes are used to bill for telebehavioral and telemental health services and have been codified into the current Medicare Physician Fee Schedule (PFS). Providers should bill with POS 02 for all virtual care claims, as we updated our claims systems to ensure providers receive 100 percent of face-to-face reimbursement for covered virtual care when using POS 02. Effective with January 1, 2021 dates of service, we implemented a new Virtual Care Reimbursement Policy. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. Cigna covers diagnostic antibody tests when the results of the antibody test will be used to aid in the diagnosis of a condition related to COVID-19 antibodies (e.g., Multisystem Inflammatory Syndrome). Refer to the Telemedicine Website for a list of billing codes which may be used with Place of Service (POS) 02 or 10. Talk to board-certified dermatologists without an appointment for customized care for skin, hair, and nail conditions. No. Neither U0003 nor U0004 should be used for tests that are used to detect COVID-19 antibodies. We recommend providers bill POS 02 beginning July 1, 2022 for virtual services (instead of a face-to-face POS). Federal government websites often end in .gov or .mil. For dates of service April 1 - June 30, 2022, Cigna will apply a 1% payment adjustment. This article was updated on March 28, 2020 by adding a link to American Specialty Health and updating the place of service code to use on the 1500-claim form. It must be initiated by the patient and not a prior scheduled visit. Cigna will determine coverage for each test based on the specific code(s) the provider bills. Therefore, to increase convenient 24/7 access to care if a customers preferred provider is unavailable in-person or virtually, covered virtual care is also available through national virtual care vendors like MDLive. For details, see the CMS document titled Place of Service Codes for Professional Claims Database (updated September 2021). Coverage reviews for appropriate levels of care and medical necessity will still apply. All Cigna Customers will pay $0 ingredient cost while funded by government, while Cigna commercial customers will pay up to a $6 dispensing fee when obtained at a pharmacy where the medications are available. Total 0 Results. Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. Non-residential Substance Abuse Treatment Facility, Non-residential Opioid Treatment Facility, A location that provides treatment for opioid use disorder on an ambulatory basis. CMS now defines these two telemedicine place of service (POS) codes: POS 02: Telehealth Provided Other than in Patient's Home Descriptor: The location where health services and health related services are provided or received, through telecommunication technology. M0222 (administration in facility setting): $350.50, M0223 (administration in home setting): $550.50. TheraThink.com 2023. Listed below are place of service codes and descriptions. As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. Cigna covers Remdesivir for the treatment of COVID-19 when administered in inpatient or outpatient settings consistent with EUA usage guidelines and Cigna's Drug and Biologic Coverage Policy. Providers could deliver any face-to-face service on their fee schedule virtually, including those not related to COVID-19, for dates of service through December 31, 2020. Providers receive reasonable reimbursement consistent with national CMS rates for administering EUA-approved COVID-19 vaccines. 1 In an emergency, always dial 911 or visit the nearest hospital. Yes. A location where providers administer pneumococcal pneumonia and influenza virus vaccinations and submit these services as electronic media claims, paper claims, or using the roster billing method. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. Toll Free Call Center: 1-877-696-6775. If you are looking for more comprehensive implementation . While the policy - announced in United's . Cigna covers FDA EUA-approved laboratory tests. Cigna will cover the administration of the COVID-19 vaccine with no customer cost-share even when administered by a non-participating provider following the guidance above. Additionally, Cigna understands the tremendous pressure our health care delivery systems are under and will factor in the current strain on health care systems and incorporate this information into retrospective coverage reviews. Thank you. A facility, other than a hospital's maternity facilities or a physician's office, which provides a setting for labor, delivery, and immediate post-partum care as well as immediate care of new born infants. At this time, providers who offer virtual care will not be specially designated within our public provider directories. Effective January 1, 2022, eConsults remain covered, but cost-share applies for all covered services. The POS Workgroup is revising the description of POS code 02 and creating a new POS code 10 to meet the overall industry needs, as follows: 1. Reimbursement, when no specific contracted rates are in place, are as follows: No. Informing Cigna prior to delivering services in other states can help to ensure claims are adjudicated correctly when submitted with addresses in states other than the provider's usual location. No authorization is required for the procurement or administration of COVID-19 infusion treatments. Comprehensive Outpatient Rehabilitation Facility. How Can You Tell Which Specific Technology is Reimbursable? As of February 16, 2021 dates of service, these treatments remain covered, but with standard customer cost-share. On-demand virtual care for minor medical conditions, Talk therapy and psychiatry from the privacyof home. When specific contracted rates are in place for COVID-19 specimen collection services, Cigna will reimburse covered services at those contracted rates. Update to the telehealth Place of Service (POS) code Telehealth continues to be an integral part of providing safe and convenient health care visits for Medicare Advantage beneficiaries. Cigna will determine coverage for each test based on the specific code(s) the provider bills. For the purposes of private practice, the three most common service codes therapists are likely to bill are "11" (office), "12" (in-home services), and "2" (telehealth). When performing tests for these purposes, providers should bill the appropriate laboratory code (e.g., U0002) following our existing billing guidelines and testing coverage policy, and use the diagnosis code Z02.79 to indicate the test was performed for return-to-work or diagnosis code Z02.0 to indicate the test was performed for return-to-school purposes. Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. The location where health services and health related services are provided or received, through telecommunication technology. CPT 99490 covers at least 20 minutes of non-face-to-face chronic care management services provided by clinical staff. Please note that our interim COVID-19 virtual care guidelines were in place until December 31, 2020. Concurrent review will start the next business day with no retrospective denials. Therefore, we will not enforce an administrative denial for failure to secure authorization (FTSA)on appeal if an extenuating circumstance due to COVID-19 applied. MLN Matters article MM12427, New modifications to place of service (POS) codes for telehealth. There may be limited exclusions based on the diagnoses submitted. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. Please review the Virtual Care Reimbursement Policy for additional details on the added codes. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. For services where COVID-19 is not the initial clinical presentation (e.g., appendectomy, labor and delivery, etc. Yes. (This code is available for use effective January 1, 2013 but no later than May 1, 2013), A portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. Please note that while Cigna Medicare Advantage plans do fully cover the costs for COVID-19 tests done in a clinical setting, costs of at-home COVID-19 tests are not a covered benefit. The Virtual Care Reimbursement Policy also applies to non-participating providers. Because we believe virtual care has the potential to help you attract and retain patients, reduce access barriers, and contribute to your ability to provide the right care at the right time, we implemented a Virtual Care Reimbursement Policy for commercial medical services, effective January 1, 2021.1 This policy ensures you can continue to receive ongoing reimbursement for virtual care provided to your patients with Cigna commercial medical coverage.2. 1. If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice. Because most standard Cigna client benefit plans do not extend coverage to screening services when performed for employment reasons (e.g., occupational physical examination), virtual care screening services will generally not be covered solely for return-to-work purposes. What place of service code should be used for telemedicine services? No. Yes. If a provider was reimbursed for a face-to-face service per their existing fee schedule, then they were reimbursed the same amount even if they delivered the service virtually. Cigna offers a number of virtual care options depending on your plan. In these cases, the provider should bill as normal on a UB-04 claim form with the appropriate revenue code and procedure code, and also append the GQ, GT, or 95 modifier. A location which provides treatment for substance (alcohol and drug) abuse on an ambulatory basis. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. While we will not reimburse the drug itself when a health care provider receives it free of charge, we request that providers bill the drug on the claim using the CMS code for the specific drug (e.g., Q0243 for Casirivimab and Imdevimab), along with a nominal charge (e.g., $.01). If an urgent care center administers a quick uniform screening (questionnaire) that does not result in a full evaluation and management service of any level and then performs a COVID-19 test OR a collection service, they should bill only the laboratory code OR collection code. As always, we remain committed to providing further updates as soon as they become available. Therefore, effective with August 15 dates of service, Cigna will reimburse providers consistent with CMS rates for doses of bebtelovimab that they purchase directly from the manufacturer. This policy applied to customers in the United States who are covered under Cigna's employer/union sponsored insured group health plans, insured plans for US-based globally mobile individuals, Medicare Advantage, and Individual and Family Plans (IFP). The test is FDA approved or cleared or have received Emergency Use Authorization (EUA); The test is run in a laboratory, office, urgent care center, emergency room, drive-thru testing site, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. Cigna Telehealth Place of Service Code: 02 Cigna Telehealth CPT Code Modifier: 95 We charge a percentage of the allowed amount per paid claim (only paid claims) No per claim submission fee No annual or monthly subscription fee No. However, providers are required to attest that their designated specialty meets the requirements of Cigna. If a hospitalist is the treating provider, they would not be reimbursed for two services on the same day, as only one service is reimbursed per day, regardless of billing method. A provider should bill on the same form they usually do (e.g., CMS 1500 or UB-04) as when they provide the service face-to-face. Cigna Telehealth Place of Service Code: 02. We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. When specific contracted rates are in place for diagnostic COVID-19 tests, Cigna will reimburse covered services at those contracted rates. Diagnostic tests, which indicate if the individual carries the virus and can infect others, Serology (i.e., antibody) tests, which indicate if the individual had a previous infection and has now potentially developed an immune response, An individual seeks and receives a COVID-19 diagnostic test from a licensed or authorized health care provider; or, A licensed or authorized health care provider refers an individual for a COVID-19 diagnostic test; and, The laboratory test is FDA approved or cleared or has received Emergency Use Authorization (EUA); and, The test is run in a laboratory, office, urgent care center, emergency room, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU; and, The results of a molecular or antigen test are non-diagnostic for COVID-19 and the results of the antibody test will be used to aid in the diagnosis of a condition related to COVID-19 antibodies (e.g., Multisystem Inflammatory Syndrome); and. .gov This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. Cigna has not lifted precertification requirements for scheduled surgeries. Locations may have included hospitals, rehabilitation centers, skilled nursing facilities, temporary hospitals, or any other facility where treatment is generally provided. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. COVID-19 OTC tests used for employment, travel, participation in sports or other activities are not covered under this mandate. Providers can bill code G2012 for a quick 5-10 minute phone conversation as part of our R31 Virtual Care Reimbursement Policy, with cost-share waived through at least May 11, 2023 for customers when the conversation is related to COVID-19. Urgent care centers can bill their global S code when a significant and separately identifiable service is performed at the same time as the administration of the vaccine, but will only be reimbursed for both services when their contract allows it (similar to how they may be reimbursed today for flu shot administration). All Time (0 Recipes) Past 24 Hours Past Week Past month. List the address of the physician for the telehealth visit on the CMS1500 claim. Location, other than a hospital or other facility, where the patient receives care in a private residence. A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? Last updated February 15, 2023 - Highlighted text indicates updates. Inflammation, sores or infection of the gums, and oral tissues, Guidance on whether to seek immediate emergency care, Board-certified dermatologists review pictures and symptoms; prescriptions available, if appropriate, Care for common skin, hair and nail conditions including acne, eczema, psoriasis, rosacea, suspicious spots, and more, Diagnosis and customized treatment plan, usually within 24 hours. Over the past several years and accelerated during COVID-19 we have collaborated with and sought feedback from many local and national medical societies, provider groups in our network, and key collaborative partners that have suggested certain codes and services that should be addressed in a virtual care reimbursement policy. Considering the pressure facilities are under, Cigna will extend the authorization approval window from three months to six months on request. To sign up for updates or to access your subscriber preferences, please enter your contact information below. One of our key goals is to help your patients connect to affordable, predictable, and convenient care anytime, anywhere. For example, talking to a board-certified doctor for a minor medical issue costs less than an ER or urgent care center, and may even be less than an in-office Primary Care Provider (PCP) visit. Store and forward communications (e.g., email or fax communications) are not reimbursable. Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. You can call, text, or email us about any claim, anytime, and hear back that day. A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided. When all requirements are met, covered services are currently reimbursed at 100% of face-to-face rates (i.e., parity). NOTE: Please direct questions related to billing place of service codes to your Medicare Administrative Contractor (MAC) for assistance. While we encourage providers to bill virtual care consistent with an office visit and understand that certain services can be time consuming and complex even when provided virtually we strongly encourage providers to be cognizant when billing level four and five codes for virtual services. We do not expect smaller laboratories or doctors' offices to be able to perform these tests. Yes. In these cases, the urgent care center should append a GQ, GT, or 95 modifier, and we will reimburse the full face-to-face rate for insured and Non-ERISA ASO customers in states where telehealth parity laws exist. TheraThink provides an affordable and incredibly easy solution. As of July 1, 2022, we request that providers bill with POS 02 for all virtual care. 200 Independence Avenue, S.W. They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. Yes. No. Contracted providers cannot balance bill customers for non-reimbursable codes. When no specific contracted rates are in place, Cigna will reimburse all covered COVID-19 diagnostic tests consistent with CMS reimbursement to ensure consistent, timely, and reasonable reimbursement. Similarly, if a cardiologist is brought in to consult in a face-to-face setting within a facility setting, that cardiologist can also provide services virtually billing a face-to-face evaluation and management (E&M) visit (the same code[s] on their fee schedule and the same claim form [e.g., CMS 1500 or UB-04]). This will help us to meet customers' clinical needs and support safe discharge planning. Cigna will not make any limitation as to the place of service where an eConsult can be used. A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician's office. We continue to make several other accommodations related to virtual care until further notice. At a minimum, we will always follow Centers for Medicare & Medicaid Services (CMS) telehealth or state-specific requirements that apply to telehealth coverage for our insurance products. This form can be completed here:https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf. As always, we remain committed to ensuring that: Yes. Note that billing B97.29 will not waive cost-share. Excluded physician services may be billed all continue to be appropriate to use at this time. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). We maintain all current medical necessity review criteria for virtual care at this time. For telephone services only, codes are time based. Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. In addition to the in-office care that you deliver today, we encourage you to consider offering virtual care to your patients with Cigna coverage as well and ensure theyre aware that you can continue to offer ongoing covered virtual care as they need it and as its medically appropriate. Yes. Service performed: OEce or other outpatient visit for the evaluation and management of a new patient CPT code billed: 99202 Modier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): 100% of face-to-face rate Customer cost-share: Applies consistent with When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. As of July 1, 2022, standard credentialing timelines again apply. A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders. Please visit. 4. Yes. In these cases, the provider should bill as normal on a UB-04 claim form with the appropriate revenue code and procedure code, and also append the GQ, GT, or 95 modifier. Through March 31, 2021, if the customer already had an approved authorization request for the service, another precertification request was not needed if the patient is being referred to another similar participating provider that offers the same level of care (e.g., getting a CT scan at another facility within the same or separate facility group). Speak with a provider online and discuss your lab work, biometric screenings. ), Preventive care codes (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) (Effective with January 29, 2022 dates of service), A quick 5- to 10-minute telephone conversation between a provider and their patient (G2012), eConsults (99446-99449, 99451, and 99452), Virtual home health services (G0151, G0152, G0153, G0155, G0157, G0158, G0299, G0300, G0493, S9123, S9128, S9129, and S9131). U.S. Department of Health & Human Services No additional credentialing or notification to Cigna is required. Through December 31, 2020 dates of service, providers could deliver virtual neuropsychological and psychological testing services and bill their regular face-to-face CPT codes that were on their fee schedule . While services billed on a UB-04 are out of scope for the new policy, we will continue to evaluate facility-based services for future policy updates. For telehealth services rendered by a facility provider, report the CPT/HCPCS code with the applicable revenue code as would normally be done for an in-person visit, and also append either modifier 95 or GT. new codes. Under normal circumstances, the provider would bill with the Place of Service code 2, to indicate the care was rendered via telehealth. As long as one of these modifiers is included for the appropriate procedure code(s), the service will be considered to have been performed virtually. Throughout the pandemic, the emergency use authorized monoclonal antibody drug bebtelovimab was purchased by the federal government and offered to providers for free. POS 02: Telehealth Provided Other than in Patient's Home Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. Our newest Playbook in the series focuses on the implementation of telehealth (PDF), defined as real-time, audio-visual visits between a clinician and patient. Yes. Providers can call Cigna customer service at 1.800.88Cigna (882.4462) to check a patients eligibility information, including if their plan offers coverage for these purposes. Youll receive a summary of your screening results for your records. 3. Yes. Specialist to specialist (e.g., ophthalmologist requesting consultation from a retina specialist, orthopedic surgeon requesting consultation from an orthopedic surgeon oncologist, cardiologist with an electrophysiology cardiologist, and obstetrician from a maternal fetal medicine specialist), Hospitalist requests an infectious disease consultation for pulmonary infections to guide antibiotic therapy, The ICD-10 code that represents the primary condition, symptom, or diagnosis as the purpose of the consult; and. Providers that receive the COVID-19 vaccine free of charge from the federal government are prohibited from seeking reimbursement from consumers for vaccine administration costs whether as cost sharing or balance billing. Virtual care (also known as telehealth, or telemedicine) is the use of technology to connect with a provider by video or phone using a computer or mobile device. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. The U.S. Food and Drug Administration (FDA) recently approved for emergency use two prescription medications for the treatment of COVID-19: PaxlovidTM (from Pfizer) and molnupiravir (from Merck). Cigna ultimately looks to the FDA, CDC, and ACIP to determine these factors. To help remove any barriers to receive testing, Cigna will cover any diagnostic molecular or antigen diagnostic test for COVID-19, including rapid tests and saliva-based tests, through at least May 11, 2023. When no contracted rates are in place, Cigna will reimburse covered diagnostic serology laboratory tests consistent with CMS reimbursement, including $42.13 for code 86769 and $45.23 for code 86328, to ensure consistent, timely, and reasonable reimbursement. Depending on your plan and location, you can connect with board-certified medical providers, dentists, and licensed therapists online using a phone, tablet, or computer. Yes. **, Watch this short video to learn more about virtual care with MDLivefor Cigna.(Length: 00:01:33). Until further notice, we will continue to made additional virtual care accommodations by allowing: eConsults are when a treating health care provider seeks guidance from a specialist physician through electronic means (e.g., phone, Internet, EHR consultation) to help manage care that is beyond the treating health care provider's usual practice.Typical examples include: Yes. Per CMS, U0003 and U0004 should be used to bill for tests that would typically be billed by 87635 and U0002 respectively, except for when the tests are performed with these high-throughput technologies. 24/7, live and on-demand for a variety of minor health care questions and concerns. A facility or distinct part of a facility for psychiatric care which provides a total 24-hour therapeutically planned and professionally staffed group living and learning environment. As of January 1, 2022, a new POS code has been approved to report more specifically where services were provided. Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication). Hospitals are still required to make their best efforts to notify Cigna of hospital admissions in part to assist with discharge planning. POS codes are two-digit codes reported on . Additional FDA EUA approved vaccines will be covered consistent with this guidance.