The ICD-10 codes for the reason of the encounter should be billed in the primary position. Further, we will continue to monitor virtual care health outcomes and claims data as well as provider, customer, and client feedback to ensure that our reimbursement and coverage strategy continues to meet the needs of those we serve. No. Transport between facilities such as hospitals and SNFs and hospitals and Acute Rehab centers is also covered without prior authorization. To receive payment equivalent to a normal face-to-face visit you will not bill POS 2 and instead will follow Medicare guidance to bill POS 11 as if care was delivered in the office during COVID-19. We recommend providers bill POS 02 beginning July 1, 2022 for virtual services (instead of a face-to-face POS). Official websites use .govA The interim COVID-19 virtual care guidelines were solely in place through December 31, 2020, and this new policy took effect on January 1, 2022. For services included in our Virtual Care Reimbursement Policy, a number of general requirements must be met for Cigna to consider reimbursement for a virtual care visit. Telehealth CPT codes 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (20-30 minutes) Reimbursements match similar in-person services, increasing from about $14-$41 to about $60-$137, retroactive to March 1, 2020 For dates of service beginning July 1, 2022, Cigna will apply a 2% 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. No. Is Face Time allowed? Cigna covers FDA EUA-approved laboratory tests. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. For telehealth, the 95 modifier code is used as well. 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. Toll Free Call Center: 1-877-696-6775. Mid-level practitioners (e.g., physician assistants and nurse practitioners) can also provide services virtually using the same guidance. This eases coordination of benefits and gives other payers the setting information they need. 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). 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. Telehealth claims with any other POS will not be considered eligible for reimbursement. Virtual care offered by Urgent Care Centers billing with code S9083 is reimbursable until further notice. No. No. Specimen collection is not generally paid in addition to other services on the same date of service for the same patient whether billed on the same or different claims by the same provider. Store and forward communications (e.g., email or fax communications) are not reimbursable. 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. Listing Results Cigna Telehealth Place Of Service. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. A facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on a 24-hour basis, by or under the supervision of a physician. As of February 16, 2021 dates of service, these treatments remain covered, but with standard customer cost-share. What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? When administered consistently with Cigna's Drug and Biologics policy and EUA usage guidelines, Cigna will reimburse the infusion and post-administration monitoring of the listed treatments at contracted rates when specific contracted rates are in place for COVID-19 services. CMS officially has designated a Place of Service code for all of the telehealth to be "02" starting April 1, 2020. Live-guided relaxation by telephone Available for all providers at no cost Every Tuesday at 5:00pm ET Call 866.205.5379, enter passcode 113 29 178, and then press # Additional Resources Cigna Medicare Billing guidelines and telehealth Cigna Dental Interim Communication to Providers QualCare Workers Compensation Interim billing guidance When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. The codes may only be billed once in a seven day time period. No. A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician. Cigna allows modifiers GQ, GT, or 95 to indicate virtual care for all services. Federal government websites often end in .gov or .mil. When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9. Cigna remains adequately staffed to respond to all new precertification requests for elective procedures within our typical timelines. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board. For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. *Please Note: virtual check-in and E-visit codes must be billed with Place of Service (POS) 02 and modifier GT. When billing for telehealth, it's unclear what place of service code to use. Certain client exceptions may apply to this guidance. 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. Providers should bill one of the above codes, along with: No. Talk directly to board-certified providers 24/7 by video or phone for help with minor, non-life-threatening medical conditions1. Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. Through this feedback and research, we developed a list of covered services that we believe are most appropriate to be offered virtually across multiple specialties. Other place of service not identified above. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). An official website of the United States government While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. 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. It remains expected that the service billed is reasonable to be provided in a virtual setting. (As of 10/14/2020) Where can providers access the telemedicine policy and related codes? Details, Watch this short video to learn more about virtual care with MDLive. 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 . Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 The interim COVID-19 virtual care guidelines as outlined on this page were in place for dates of service through December 31, 2020. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. Yes. 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. 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 It's our goal to ensure you simply don't have to spend unncessary time on your billing. Per usual protocol, emergency and inpatient imaging services do not require prior authorization. Considering the pressure facilities are under, Cigna will extend the authorization approval window from three months to six months on request. POS 02: Telehealth Provided Other than in Patient's Home ** The Benefits of Virtual Care No waiting rooms. Audio -only CPT codes 98966 98968 and 99441 We are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. Yes. These codes should be used on professional claims to specify the entity where service (s) were rendered. The codes should not be billed if the sole purpose of the consultation is to arrange a transfer of care or a face-to-face visit. Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. Please review the Virtual Care Reimbursement Policy for additional details on the added codes. Recent guidelines have recommended keeping the normal service facility that you are registered under in your CMS-1500. 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. 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. Free Account Setup - we input your data at signup. To speak with a dentist,log in to myCigna. 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. Store and forward communications (e.g., email or fax communications) are not reimbursable. Urgent Care vs. the Emergency Room7 Ways to Help Pay Less for Out-of-Pocket Costs, What is Preventive Care?View all articles. Precertification (i.e., prior authorization) requirements remain in place. Similar to other providers and facilities, urgent care centers should bill just the appropriate COVID-19 vaccine administration code when that is the only service they are providing.Consistent with our reimbursement strategy for all other providers, urgent care centers will be reimbursed for covered vaccine administration services at contracted rates when specific contracted rates are in place for vaccine administration codes. 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. No. You can call, text, or email us about any claim, anytime, and hear back that day. Activate your myCigna account nowto get access to a virtual dentist. For providers whose contracts utilize a different reimbursement Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF). The site is secure. 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. 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. Customer cost-share will be waived for COVID-19 related virtual care services through at least. Neither U0003 nor U0004 should be used for tests that are used to detect COVID-19 antibodies. Listed below are place of service codes and descriptions. Speak with a provider online and discuss your lab work, biometric screenings. We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically Note that billing B97.29 will not waive cost-share. We did not make any requirements regarding the type of technology used. 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. These codes should be used on professional claims to specify the entity where service(s) were rendered. 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. You want to know you can call your billing admin, a real person you've already spoken with, and get immediate answers about your claims. That is why in 2015, CMS began reimbursing providers for a program called non-complex Chronic Care Management (CCM), billed as the new code CPT 99490. Intermediate Care Facility/ Individuals with Intellectual Disabilities. If a provider typically delivered face-to-face services in a facility setting, that provider could also deliver any appropriate service virtually consistent with existing Cigna policies through December 31, 2020 dates of service. Modifier 95, indicating that you provided the service via telehealth. Cigna will allow commercial and behavioral providers who are participating with Cigna (and who have up-to-date credentialing) to provide in-person or virtual care in other states to the extent that the scope of the license and state regulations allow such care to take place. 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. 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. 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. Yes. A location, not part of a hospital and not described by any other Place of Service code, that is organized and operated to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to outpatients only. Separate codes providers may use to bill for supplies are generally considered incidental to the overall primary service and are not reimbursed separately. 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. Important notes, What the accepting facility should know and do. ICD-10 diagnosis codes that generally reflect non-covered services are as follows. Cigna does require prior authorization for fixed wing air ambulance transport. MVP will email or fax updates to providers and will update this page accordingly. 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. Refer to the Telemedicine Website for a list of billing codes which may be used with Place of Service (POS) 02 or 10. Youll receive a summary of your screening results for your records. Diagnoses requiring testing cannot be confirmed. Telehealth can provide many benefits for your practice and your patients, including increased 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. Similar to other vaccination administration (e.g., a flu shot), an E&M service and 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. 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. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. Yes. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. Yes. For dates of service February 4, 2020 through February 15, 2021, Cigna covered COVID-19 treatments without customer cost-share. Cigna will cover Evusheld when administered for the prevention of COVID-19 in certain adults and pediatric individuals consistent with FDA EUA guidance and Cigna's Drug and Biologics Coverage Policy, effective with dates of service on and after December 8, 2021.Please note that Cigna does not require prior authorization for the use or administration of Evusheld. Yes. No. A walk-in health clinic, other than an office, urgent care facility, pharmacy or independent clinic and not described by any other Place of Service code, that is located within a retail operation and provides, on an ambulatory basis, preventive and primary care services. Consistent with federal guidelines for private insurers, Cigna commercial will cover up to eight over-the-counter (OTC) diagnostic COVID-19 tests per month (per enrolled individual) with no out-of-pocket costs for claims submitted by a customer under their medical benefit. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. This guidance applies to all providers, including laboratories. Before sharing sensitive information, make sure youre on a federal government site. Yes. Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. Per usual policy, Cigna does not require three days of inpatient care prior to transfer to a SNF. 3. 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. As of July 1, 2022, we request that providers bill with POS 02 for all virtual care. Below is a definition of POS 02 and POS 10 for CMS-1500 forms, alongside a list of major insurance brands and their changes. Providers should bill this code for dates of service on or after December 23, 2021. 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. POS codes are two-digit codes reported on . Yes. You free me to focus on the work I love!. were all appropriate to use). Effective with January 1, 2021 dates of service, we implemented a new Virtual Care Reimbursement Policy. Cigna covers pre-admission and pre-surgical COVID-19 testing with no customer cost-share when performed in an outpatient setting through at least May 11, 2023. 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 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. Cigna will factor in the current strain on health care systems and will incorporate this information into retrospective reviews. No. We are your billing staff here to help. 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. 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. Cigna understands the tremendous pressure our healthcare delivery systems are under. A facility which primarily provides to residents skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care services above the level of custodial care to other than individuals with intellectual disabilities. Obtain your Member Code with just HK$100. A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment 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. Yes. For more information, see the resources along the right-hand side of the screen. 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. Yes, the cost-share waiver for COVID-19 treatment ended on February 15, 2021. Let us handle handle your insurance billing so you can focus on your practice. 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). The additional 365 days added to the regular timely filing period will continue through the end of the Outbreak Period, defined as the period of the National Emergency (which is declared by the President and must be renewed annually) plus 60 days. Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually until further notice. For virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02. Please visit. 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. (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. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. Cigna recommends video services but allows telephonic sessions; however they may require review for medical necessity. Effective Jan 1, 2022, the CMS changed the definition of POS code 02 we've been using for telehealth, and introduced a second telehealth POS code 10: POS 10: Telehealth to a client located at home (does not apply to clients in a hospital, nursing home or assisted living facility) POS 02: Telehealth to a client who is not located at home Certain home health services can be provided virtually using synchronous communication as part of our R31 Virtual Care Reimbursement Policy. To this end, we will use all feedback we receive to consider further updates to our policy. POS 10 Telehealth provided in a patient's home was created for services provided remotely to a patient in their private residence. While we will not reimburse the drug itself when a provider receives it free of charge, we request that providers continue to bill the drug on the claim using the CMS code for the specific drug, along with a nominal charge (e.g., $.01), to assist with tracking purposes. Cigna Telehealth Service is a one-stop mobile app for having virtual consultation with doctors in Hong Kong as well as getting Covid-19 self-test kit & medication delivered to your doorstep. 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. Effective January 1, 2021, we implemented a new. Total 0 Results. You get connected quickly. 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. 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 . 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. All Rights Reserved. "Medicare hasn't identified a need for new POS code 10. Cigna continues to require prior authorization reviews for routine advanced imaging. New/Modifications to the Place of Service (POS) Codes for Telehealth This Change Request implements a new POS code (10) for Telehealth, as well as modifies the description for the existing POS code (02) for Telehealth. 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. 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 Inpatient COVID-19 care that began on or before February 15, 2021, and continued on or after February 16, 2021 at the same facility, will have cost-share waived for the entire course of the facility stay. A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services rendered by, or under the supervision of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients. 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. Telephone, Internet, or electronic health record consultations of less than five minutes should not be billed. No virtual care modifier is needed given that the code defines the service as an eConsult. A short term accommodation such as a hotel, camp ground, hostel, cruise ship or resort where the patient receives care, and which is not identified by any other POS code. As always, we remain committed to ensuring that: Yes. incorporated into a contract. How Can You Tell Which Specific Technology is Reimbursable? When no specific contracted rates are in place, providers will be reimbursed $40 per dose for general vaccine administration and an additional $35.50 per dose for administering it in a home setting for total reimbursement of $75.50 per vaccine dose. identify telehealth or telephone (audio only) services that were historically performed in the office or other in person setting (E.g. 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.