Cost-share will be waived for COVID-19 related services only when providers bill the appropriate ICD-10 code and modifier CS. An official website of the United States government Prior to the COVID-19 PHE, the patient's place of service was indicated with code 02, which previously indicated all telehealth patient sites. Store and forward communications (e.g., email or fax communications) are not reimbursable. Are reasonable to be provided in a virtual setting; and, Are reimbursable per a providers contract; and, Use synchronous technology (i.e., audio and video) except 99441 - 99443, which are audio-only services, Urgent care centers to offer virtual care when billing with a global S9083 code, Most synchronous technology to be used (e.g., FaceTime, Skype, Zoom, etc. 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]). Note: We only work with licensed mental health providers. When no specific contracted rates are in place, Cigna will reimburse the administration of all EUA vaccines at the established national CMS rates when claims are submitted under the medical benefit to ensure timely, consistent, and reasonable reimbursement. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. Yes. POS 11, 19 and 22) modifier GT or 95 (or GQ for Medicaid) must be used. 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. Providers receive reasonable reimbursement consistent with national CMS rates for administering EUA-approved COVID-19 vaccines. 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). Outpatient E&M codes for new and established patients (99202-99215) Physical and occupational therapy E&M codes (97161-97168) Telephone-only E&M codes (99441-99443) Annual wellness visit codes (G0438 and G0439) For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. It must be initiated by the patient and not a prior scheduled visit. This includes when done by any provider at any site, including an emergency room, free-standing emergency room, urgent care center, other outpatient setting, physicians office, etc. No additional modifiers are necessary. 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. Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. For telephone services only, codes are time based. Considering the pressure facilities are under, Cigna will extend the authorization approval window from three months to six months on request. These codes should be used on professional claims to specify the entity where service (s) were rendered. TheraThink.com 2023. Other place of service not identified above. Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. Standard customer cost-share applies. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. As of February 16, 2021 dates of service, these treatments remain covered, but with standard customer cost-share. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. 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. To speak with a dentist,log in to myCigna. Yes. This includes providers who typically deliver services in a facility setting. representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). When billing, you must use the most appropriate code as of the effective date of the submission. 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. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. Except for the telephone-only codes (99441-99443), all services must be interactive and use both audio and video internet-based technologies (synchronous communication) in order to be covered. Patient is not located in their home when receiving health services or health related services through telecommunication technology. There are two primary types of tests for COVID-19: A serology (i.e., antibody) test for COVID-19 is considered diagnostic and covered without cost-share through at least May 11, 2023 when ALL of the following criteria are met: When specific contracted rates are in place for diagnostic COVID-19 serology tests, Cigna will reimburse covered services at those contracted rates. For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. Non-contracted providers should use the Place of Service code they would have used had the . "All Rights Reserved." This website and its contents may not be reproduced in whole or in part without . MLN Matters article MM12427, New modifications to place of service (POS) codes for telehealth. End-Stage Renal Disease Treatment Facility. COVID-19 OTC tests used for employment, travel, participation in sports or other activities are not covered under this mandate. Providers should append the GQ, GT, or 95 modifier and Cigna will reimburse them consistent with their face-to-face rates. When the tests are performed for general population or public health surveillance, for employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19, Cigna will generally not cover in-vitro molecular, antigen, or antibody tests for asymptomatic individuals. The interim COVID-19 virtual care guidelines as outlined on this page were in place for dates of service through December 31, 2020. No. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. When no specific contracted rates are in place, we will reimburse this code at $22.99 consistent with CMS pricing to ensure consistent, timely, and reasonable reimbursement. Cigna will not reimburse providers for the cost of the vaccine itself. Yes. Diagnoses requiring testing cannot be confirmed. One of our key goals is to help your patients connect to affordable, predictable, and convenient care anytime, anywhere. Yes. Mid-level practitioners (e.g., physician assistants and nurse practitioners) can also provide services virtually using the same guidance. Modifier 95, GT, or GQ must be appended to the appropriate CPT or HCPCS procedure code(s) to indicate the service was for virtual care. Is there a code that we can use to bill for this other than 99441-99443? As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. Yes. No. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board. 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. Activate your myCigna account nowto get access to a virtual dentist. Washington, D.C. 20201 Cigna may request the appropriate CLIA-certification or waiver as well as the manufacturer and name of the test being performed. Yes. (Effective January 1, 2003). We did not make any requirements regarding the type of technology used. Share sensitive information only on official, secure websites. You'll always be able to get in touch. No waiting rooms. 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. As of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. 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. mitchellde True Blue Messages 13,505 Location Columbia, MO Best answers 2 Mar 9, 2020 #2 Those are the codes for a phone visit. Please note that cost-share still applies for all non-COVID-19 related services. At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. Please review the Virtual care services frequently asked questions section on this page for more information. The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. Telehealth claims with any other POS will not be considered eligible for reimbursement. MVP will email or fax updates to providers and will update this page accordingly. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. NOTE: Please direct questions related to billing place of service codes to your Medicare Administrative Contractor (MAC) for assistance. A facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters). If antibodies are present, it means that individual previously had a specific viral or bacterial infection - like COVID-19. 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. 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. Yes. Area (s) of Interest: Payor Issues and Reimbursement. When specific contracted rates are in place for diagnostic COVID-19 lab tests, Cigna will reimburse covered services at those contracted rates. The provider will need to code appropriately to indicate COVID-19 related services. 4 Due to state laws governing teledentistry, this service is not available to residents of Texas. Please note that this guidance applies to drive through testing as well, and includes services performed by a free-standing emergency room or any other provider. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. Total 0 Results. 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. State and federal mandates, as well as customer benefit plan designs, may supersede our guidelines. However, facilities will not be penalized financially for failure to notify us of admissions. Yes. Precertification (i.e., prior authorization) requirements remain in place. 2 Limited to labs contracted with MDLIVE for virtual wellness screenings. Unlisted, unspecified and nonspecific codes should be avoided. Speak with a provider online and discuss your lab work, biometric screenings. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. 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. Please note that HMO and other network referrals remained required through the pandemic, so providers should have continued to follow the normal process that has been in place. Approximately 98% of reviews are completed within two business days of submission. 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. If specimen collection and a laboratory test are billed together, only the laboratory test will be reimbursed. 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. PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. 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 Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication). 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. For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. Sign up to get the latest information about your choice of CMS topics. Concurrent review will start the next business day with no retrospective denials. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. While Cigna doesn't require further credentialing or license validation, and the provider can work under the scope of their license, providers are encouraged to inform Cigna when they will practice across state lines. We are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. *Please Note: virtual check-in and E-visit codes must be billed with Place of Service (POS) 02 and modifier GT. Diluents are not separately reimbursable in addition to the administration code for the infusion. First Page. This coverage began January 15, 2022 and continues through at least the end of the public health emergency (PHE) period (May 11, 2023). Cigna commercial and Cigna Medicare Advantage are waiving the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. For more information, please visit Cigna.com/Coronavirus. These codes should be used on professional claims to specify the entity where service (s) were rendered. 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. When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance. Effective with January 1, 2021 dates of service, we implemented a new Virtual Care Reimbursement Policy. When billing telehealth services, healthcare providers must bill the E&M code with place of service code 02 along with a GT or 95 modifier. on the guidance repository, except to establish historical facts. 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. Modifier 95, indicating that you provided the service via telehealth. 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. Yes. Cigna remains fully staffed, and is committed to ensuring that precertification requests are reviewed in a timely manner and that there is no interruption of claims processing or claims payments. Place of Service (POS) equal to what it would have been had the service been provided in-person. Place of Service Code Set. Phone, video, FaceTime, Skype, Zoom, etc. Certain client exceptions may apply to this guidance. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. What place of service code should be used for telemedicine services? (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. 1 A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. Effective for dates of service on and after March 2, 2020 until further notice, Cigna will cover eConsults when billed with codes 99446-99449, 99451 and 99452 for all conditions. Yes. Instead U07.1, J12.82, M35.81, or M35.89 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnoses.Please refer to the general billing guidance for additional information. 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). If you are rendering services as part of a facility (i.e., intensive outpatient program . When specific contracted rates are in place for diagnostic COVID-19 tests, Cigna will reimburse covered services at those contracted rates. Therefore, as of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. My daily insurance billing time now is less than five minutes for a full day of appointments. Below is a definition of POS 02 and POS 10 for CMS-1500 forms, alongside a list of major insurance brands and their changes. A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. The White House announced the intent to end both the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023. Routine and non-emergent transfers to a secondary facility continue to require authorization. For example, an infectious disease specialist could provide a virtual consultation for an ICU patient, document the level of care provided, bill the appropriate face-to-face E&M code with modifier GQ, GT, or 95, and be reimbursed at the face-to-face rate. new codes. Yes. over a 7-day period. 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). It's convenient, not costly. When specific contracted rates are in place for COVID-19 vaccine administration services, Cigna will reimburse covered services at those contracted rates. At this time, providers who offer virtual care will not be specially designated within our public provider directories. We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice. Let us handle handle your insurance billing so you can focus on your practice. 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. Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours. 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. While the R31 Virtual Care Reimbursement Policy that went into effect on January 1, 2021 only applies to claims submitted on a CMS-1500 claim form, we will continue to reimburse virtual care services billed on a UB-04 claim form until further notice when the services: Please note that existing reimbursement policies will apply and may affect claims payment (e.g., R30 E&M Services). We continue to make several other accommodations related to virtual care until further notice. For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. identify telehealth or telephone (audio only) services that were historically performed in the office or other in person setting (E.g. You can call, text, or email us about any claim, anytime, and hear back that day. It's our goal to ensure you simply don't have to spend unncessary time on your billing.