For additional information about our coverage of the COVID-19 vaccine, please review our. When specific contracted rates are in place for diagnostic COVID-19 lab tests, Cigna will reimburse covered services at those contracted rates. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. All Time (0 Recipes) Past 24 Hours Past Week Past month. 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. This policy will be reviewed periodically for changes based on the evolving COVID-19 PHE and updated CMS or state specific rules 1 based on executive orders. Billing the appropriate administration code will ensure that cost-share is waived. Usually not. Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. As a reminder, standard customer cost-share applies for non-COVID-19 related services. Providers that administer vaccinations to patients without health insurance or whose insurance does not provide coverage of vaccination administration fees, may be able to file a claim with the provider relief fund, but may not charge patients directly for any vaccine administration costs. Cigna will only reimburse claims for covered OTC COVID-19 tests submitted by customers under their medical benefit and by certain pharmacy retailers under the pharmacy benefit, as elected by clients. When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9. No virtual care modifier is needed given that the code defines the service as an eConsult. As a result, we did not reimburse for the drug itself when billed with Q0222.However, on August 15, drug manufacturer Eli Lilly started commercial distribution of their COVID-19 monoclonal antibody therapy, bebtelovimab (175 mg), and the federal government will no longer purchase it. 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 Certain PT, OT, and ST virtual care services remain reimbursable under the R31 Virtual Care Reimbursement Policy. Providers administering the vaccine to individuals without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the Provider Relief Fund. Cigna will reimburse Remdesivir for COVID-19 treatment when administered in inpatient or outpatient settings at the national CMS reimbursement rate (or average wholesale pricing [AWP] if a CMS rate is not available) when the drug costs are not included in case rates or per diems to ensure timely, consistent, and reasonable reimbursement. Below is a definition of POS 02 and POS 10 for CMS-1500 forms, alongside a list of major insurance brands and their changes. 1 In an emergency, always dial 911 or visit the nearest hospital. End-Stage Renal Disease Treatment Facility. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Telehealth Provided Other than in Patients Home, Process for Requesting New Codes or Modification of Existing Codes, Place of Service Codes for Professional Claims (PDF), A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to American Indians and Alaska Natives who do not require hospitalization. Let us handle handle your insurance billing so you can focus on your practice. Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004. If more than one telephone, Internet, or electronic health record contact(s) is required to complete the consultation request (e.g., discussion of test results), the entirety of the service and the cumulative discussion and information review time should be billed with a single code. 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. Cigna covered the administration and post-administration monitoring of EUA-approved COVID-19 infusion treatments with no customer-cost share for services provided through February 15, 2021. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board. Yes. Preventive care checkups and wellness screenings available at no additional cost, Routine care visits allow you to build a relationship with the same primary care provider (PCP) to helpmanage conditions, Prescriptions available through home delivery orat local pharmacies, if appropriate, Receive orders for biometrics, blood work andscreenings at local facilities, Skin conditions such as rashes, moles, eczema, and psoriasis, Care for hundreds of minor medical conditions, A convenient and affordable alternative to urgent, Schedule an appointment that works for you, You have the option to select the same provider for every session, Get prescriptions sent directly to your local pharmacy, if appropriate. Our mental health insurance billing staff is on call Monday Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy. Coverage reviews for appropriate levels of care and medical necessity will still apply. However, this added functionality is planned for a future update. For all Optum Behavioral Health commercial plans, any telehealth services provided via a real-time audio and video communication system can be billed for members at home or another location. For all virtual care services, providers should bill using a reimbursable face-to-face code, append the GQ, GT or 95 modifier, and use POS 02 as of July 1, 2022. ) Cigna covers the administration of the COVID-19 vaccine with no customer-cost share (i.e., no deductible or co-pay) when delivered by any provider. Therefore, your patients with Cigna commercial coverage can purchase OTC tests from a health care provider and seek reimbursement by billing Cigna directly following our published guidance. This is a key difference between Commercial and Medicare risk . As of January 1, 2022, a new POS code has been approved to report more specifically where services were provided. ), Preventive care services (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) [Effective with January 29, 2022 dates of service]. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. ICD-10 code U07.1, J12.82, M35.81, or M35.89. The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. This form can be completed here:https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf. We are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. Telehealth can provide many benefits for your practice and your patients, including increased A home health care provider should bill one of the covered home health codes for virtual services (G0151, G0152, G0153, G0155, G0157, G0158, G0299, G0300, G0493, S9123, S9128, S9129, and S9131) along with POS 12 and a GT or 95 modifier to identify that the service(s) were delivered using both an audio and video connection. To this end, we appreciate the feedback and deep collaboration weve had with provider groups and medical societies regarding virtual care. For more information, see the resources along the right-hand side of the screen. Yes. The covered procedure codes for E-visits/online portal services include: 99421, 99422, 99423, G2061, G2062, G2063. Yes. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. (Effective January 1, 2016). lock Free Account Setup - we input your data at signup. Providers should bill one of the above codes, along with: No. This new initiative enables payment from original Medicare for submitted claims directly to participating eligible pharmacies and other health care providers, which allows Medicare beneficiaries to receive tests at no cost. On-demand virtual care for minor medical conditions, Talk therapy and psychiatry from the privacyof home. Thank you. Note: We only work with licensed mental health providers. MLN Matters article MM7631, Revised and clarified place of service (POS) coding instructions. A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. Youll receive a summary of your screening results for your records. Routine and non-emergent transfers to a secondary facility continue to require authorization. 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. Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. If the individual test is not part of a panel, but is part of a series of other pathogen tests that are performed, unbundling edits may apply. It must be initiated by the patient and not a prior scheduled visit. To this end, we will use all feedback we receive to consider further updates to our policy. (Receive an extra 25% off with payment made by Mastercard.) Talk directly to board-certified providers 24/7 by video or phone for help with minor, non-life-threatening medical conditions1. Modifier 95, indicating that you provided the service via telehealth. Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. Effective January 1, 2021, we implemented a new. When a customer receives virtual care services from their regular doctor (or any other provider) as part of this policy and when the provider bills with POS 02 customers with certain benefit plans may have a lower cost-share. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. This means that providers could perform services for commercial Cigna medical customers in a virtual setting and bill as though the services were performed face-to-face. Reimbursement, when no specific contracted rates are in place, are as follows: No. And as your patients seek more convenient and safe care options, we continue to see growing interest in virtual care (i.e., telehealth) especially from consumers and their providers who want to ensure they have greater access and connection to each other. Yes, the cost-share waiver for COVID-19 treatment ended on February 15, 2021. Recent guidelines have recommended keeping the normal service facility that you are registered under in your CMS-1500. Obtain your Member Code with just HK$100. 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). over a 7-day period. They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. If the home health service(s) are done for COVID-19 related treatment, cost-share will be waived for covered services through February 15, 2021 when providers bill ICD-10 code U07.1, J12.82, M35.81, or M35.89. As of April 4, 2022, individuals with Medicare Part B and Medicare Advantage plans can get up to eight OTC tests per calendar month from participating pharmacies and health care providers for the duration of the COVID-19 public health emergency (PHE). Reimbursement will be consistent as though they performed the service in a face-to-face setting. UnitedHealthcare (UHC) is now requiring physicians to bill eligible telehealth services with place of service (POS) 02 for commercial products. No. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. Whether physicians report the audio-only encounter to a private payer as an office visit (99201-99215) or telephone E/M service (99441-99443) will depend on what the physician is able to document . A certified facility which is located in a rural medically underserved area that provides ambulatory primary medical care under the general direction of a physician. Cigna commercial and Cigna Medicare Advantage will not directly reimburse claims submitted under the medical benefit by retailers or by health care providers like hospitals, urgent care centers, and primary care groups for OTC COVID-19 tests, including when billed with CPT code K1034. Organizations that offer Administrative Services Only (ASO) plans will be opted in to waiving cost-share for this service as well. For dates of service February 4, 2020 through February 15, 2021, Cigna covered COVID-19 treatments without customer cost-share. For the R31 Virtual Care Reimbursement Policy, effective January 1, 2021, we continue to not make any requirements regarding the type of synchronous technology used until further notice. Instead, we request that providers bill POS 02 for all virtual care in support of the new client benefit plan option that lowers cost-share for certain customers who receive virtual care. A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician. Patient is not located in their home when receiving health services or health related services through telecommunication technology. Codes on the list of approved telehealth services allow for various settings, but there must be both audio and video in real time between the physician . Cigna covers C9803 with no customer cost-share for a hospital outpatient clinic visit specimen collection, including drive-thru tests, through at least May 11, 2023 only when billed without any other codes. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. Yes. 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). Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. On January 1, 2021, we implemented a Virtual Care Reimbursement Policy that ensures permanent coverage of certain virtual care services. No additional credentialing or notification to Cigna is required. You'll always be able to get in touch. Listing Results Cigna Telehealth Place Of Service. (99441, 98966, 99442, 98967, 99334, 98968). As of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. Cigna may not control the content or links of non-Cigna websites. Cost-share is waived when G2012 is billed for COVID-19 related services consistent with our, ICD-10 code Z03.818, Z11.52, Z20.822, or Z20.828, POS 02 and GQ, GT, or 95 modifier for virtual care. The COVID-19 billing and reimbursement guidelines that follow are for commercial Cigna medical services, including IFP, unless otherwise noted. Recently, the Centers for Medicare & Medicaid Services (CMS) introduced a new place-of-service (POS) code and revised another POS code in an effort to improve the reporting of telehealth services provided to patients at home as well as the coverage of telebehavioral health. Standard cost-share will apply for the customer, unless waived by state-specific requirements. new codes. Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. (Effective January 1, 2020). 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. Billing guidelines: Optum Behavioral Health will reimburse telehealth services which use standard CPT codes and a GT modifier or a Place of Service of 02 for Specimen collection will only be reimbursed in addition to other services when it is billed by an independent laboratory for travel to a skilled nursing facility (place of service 31), nursing facility (place of service 32), or to an individuals home (place of service 12) to collect the specimen. Prior to the COVID-19 PHE, the patient's place of service was indicated with code 02, which previously indicated all telehealth patient sites. While we encourage PT/OT/ST providers to follow CMS guidance regarding the use of software programs for virtual care, we are not requiring the use of any specific software program at this time. 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. As of July 1, 2022, standard credentialing timelines again apply. Federal government websites often end in .gov or .mil. Other Reimbursement Type. 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. Cigna offers a number of virtual care options depending on your plan. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of North Carolina, Inc. and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates ( see Cigna will reimburse at 100% of face-to-face rates, even when billing POS 02. Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. Reimbursement for codes that are typically billed include: Yes. Know how to bill a facility fee For services provided through February 15, 2021, providers will need to bill consistent with our interim billing guidelines by including the Diagnosis code (Dx) U07.1, J12.82, M35.81, or M35.89 on claims related to the treatment of COVID-19. Residential Substance Abuse Treatment Facility. Total 0 Results. After the emergency use authorization (EUA) or licensure of each COVID-19 vaccine product by the FDA, CMS will identify the specific vaccine code(s) along with the specific administration code(s) for each vaccine that should be billed. 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. Yes. When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance. ** The Benefits of Virtual Care No waiting rooms. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Concurrent review will start the next business day with no retrospective denials. and the home vaccine administration code (M0201) on the same claim under the medical benefit.When specific contracted rates are in place for vaccine administration services, Cigna will reimburse covered services at those contracted rates. M misstigris Networker Messages 63 Location Portland, OR Service codes Physicians: use service codes 99441-99443; Non-physicians: use 98966-98968 We're waiving copays for telehealth visits for behavioral and mental health counseling for members eligible for managed long-term services and supports (MLTSS) and Division of Developmental . Yes. Following the recent statement from the National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel indicating that a three-dose regimen of Remdesivir in the outpatient setting can be effective in preventing progression to severe COVID-19, CMS created HCPCS code J0248 when administering Remdesivir in an outpatient setting. 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. Schedule an appointment online with MDLIVE and visit a lab for your blood work and biometrics. Medicare telehealth services practitioners use "02" if the telehealth service is delivered anywhere except for the patient's home. List the address of the physician for the telehealth visit on the CMS1500 claim. Effective January 1, 2022, eConsults remain covered, but cost-share applies for all covered services. Before sharing sensitive information, make sure youre on a federal government site. HIPAA requirements apply to video telehealth sessions so please refer to our guide on HIPAA compliant video technology for telehealth to ensure youre meeting the requirements. Every provider we work with is assigned an admin as a point of contact. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. Cigna waived cost-share for COVID-19 related treatment, in both inpatient and outpatient settings, through February 15, 2021 dates of service. To increase convenient 24/7 access to care if a patients preferred provider is unavailable in-person or virtually, our virtual care platform also offers solutions that include national virtual care vendors like MDLive. HIPAA does not require patient consent for consultation and coordination of care with health care providers in the ordinary course of treatment for their patients. New/Modifications to the Place of Service (POS) Codes for Telehealth. Modifier CS for COVID-19 related treatment. If antibodies are present, it means that individual previously had a specific viral or bacterial infection - like COVID-19. Diluents are not separately reimbursable in addition to the administration code for the infusion. Providers can, however, bill the vaccine code (e.g., 91300 for the Pfizer vaccine or 91301 for the Moderna vaccine) with a nominal charge (e.g., $.01), but it is not required to be billed in order to receive reimbursement for the administration of the vaccine. 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. (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.). Please review the Virtual Care Reimbursement Policy for additional details on the added codes. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. As of February 16, 2021 dates of service, these treatments remain covered, but with standard customer cost-share. Certain virtual care services that were previously covered on an interim basis as part of our COVID-19 guidelines are now permanently covered as part of our Virtual Care Reimbursement Policy. Cigna will allow reimbursement for these codes by any provider or facility only when billed without any other codes (except where the contract allows it). Listed below are place of service codes and descriptions. The ordering provider should use the standard, existing process to submit home health orders to eviCore healthcare. When specific contracted rates are in place for COVID-19 vaccine administration services, Cigna will reimburse covered services at those contracted rates. What place of service code should be used for telemedicine services? When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. We added a number of additional codes in March and April 2022 that are now eiligible for reimbursement. Cigna will waive all customer cost-share for diagnostic services, testing, and treatment related to COVID-19, as follows: The visit will be covered without customer cost-share if the provider determines that the visit was consistent with COVID-19 diagnostic purposes. We are committed to helping providers deliver care how, when, and where it best meets the needs of their patients. Clarifying Codes G0463 and Q3014 Unfortunately, this policy also created a great deal of confusion and inconsistency among providers regarding which code to bill when providing remote clinic visits: G0463, Hospital outpatient clinic visit for assessment and management of a patient, or Q3014, Telehealth originating site facility fee. A serology test is a blood test that measures antibodies. When specimen collection is done in addition to other services on the same date of service for the same patient, reimbursement will not be made separately for the specimen collection (when billed on the same or different claims). all continue to be appropriate to use at this time. Activate your myCigna account nowto get access to a virtual dentist. PT/OT/ST providers should continue to submit virtual claims with a GQ, GT, or 95 modifier and POS 02, and they will be reimbursed at their face-to-face rates. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. Yes. An E&M service and COVID-19 vaccine administration code should only be billed when a significant and separately identifiable E&M visit was performed at the same time as the administration of the vaccine. ( While virtual care provided by an urgent care center is not covered per our R31 Virtual Care Reimbursement Policy, we continue to reimburse urgent care centers for delivering virtual care until further notice as part of our interim COVID-19 virtual care accommodations. 1995-2020 by the American Academy of Orthopaedic Surgeons. Yes. Codes 99441-99443 are non-face-to-face E/M services provided to a patient using the telephone by a physician or other QHP who may report E/M services. For example, if a patient presents at an emergency room with a suspected broken ankle after a fall and is also tested for COVID-19 during the visit, Cigna would cover services related to treating the ankle at standard customer cost-share, while the COVID-19 laboratory test would be covered at no customer cost-share. We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information. Audio-only encounters can be provided using the telephone evaluation and management codes (CPT codes. In addition, the discharging provider or primary care physician can provide the post discharge visit virtually if appropriate. We continue to monitor for any updates from the administration and are evaluating potential changes to our ongoing COVID-19 accommodations as a result of the PHE ending. Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (LINA) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (NYLGICNY) (New York, NY), formerly known as Cigna Life Insurance Company of New York. April 14, 2021. Additionally, when you bill POS 02, your patients may also pay a lower cost-share for the virtual services they receive due to a recent change in some plan benefits. Is there a code that we can use to bill for this other than 99441-99443? Modifier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): . 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. Please note that we continue to closely monitor and audit claims for inappropriate services that could not be performed virtually (e.g., acupuncture, all surgical codes, anesthesia, radiology services, laboratory testing, administration of drugs and biologics, infusions or vaccines, EEG or EKG testing, etc.). A facility that provides the following services: outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically ill, and residents of the CMHC's mental health services area who have been discharged from inpatient treatment at a mental health facility; 24 hour a day emergency care services; day treatment, other partial hospitalization services, or psychosocial rehabilitation services; screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission; and consultation and education services.