Yes. Refer to the Telemedicine Website for a list of billing codes which may be used with Place of Service (POS) 02 or 10. All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02. It's our goal to ensure you simply don't have to spend unncessary time on your billing. Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF). Cigna may not control the content or links of non-Cigna websites. Cigna will also administer the waiver for self-insured group health plans and the company encourages widespread participation, although these plans will have an opportunity to opt-out of the waiver option or opt-in to extend the waiver past February 15, 2021. a listing of the legal entities Non-residential Substance Abuse Treatment Facility, Non-residential Opioid Treatment Facility, A location that provides treatment for opioid use disorder on an ambulatory basis. We are awaiting further billing instructions for providers, as applicable, from CMS. ( 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. We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. 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. 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. 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). Urgent Care vs. the Emergency Room7 Ways to Help Pay Less for Out-of-Pocket Costs, What is Preventive Care?View all articles. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. First Page. 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. 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. 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. A facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters). We will continue to assess the situation and adjust to market needs as necessary. Yes. Yes. Cigna allows modifiers GQ, GT, or 95 to indicate virtual care for all services. Yes. Please note that Cigna temporarily increased the precertification approval window for all elective inpatient and outpatient services - including advanced imaging - from three months to six months for dates of authorization beginning March 25, 2020 through March 31, 2021. More information about coronavirus waivers and flexibilities is available on . A freestanding facility, other than a physician's office, where surgical and diagnostic services are provided on an ambulatory basis. Organizations that offer Administrative Services Only (ASO) plans will be opted in to waiving cost-share for this service as well. We covered codes 99441-99443 as part of these interim COVID-19 guidelines, and continue to cover them as part of the R31 Virtual Care Reimbursement Policy. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Antibody tests: 86328, 86769, 86408, 86409, 86413, and 0224U, Cigna covers diagnostic molecular and antigen tests for COVID-19 through at least. As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. 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. Mid-level practitioners (e.g., physician assistants and nurse practitioners) can also provide services virtually using the same guidance. Providers should bill one of the above codes, along with: No. No. Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. Home Visit Codes New Patient: 99343 Established Patient: 99349 Place of Service (POS): 12 - Home Office Visit Codes New Patient: 99203 Established Patient: 99213 Place of Service (POS): 11 - Office Telephone Call Codes Established Patient: 99442 Place of Service (POS): 11 - Office Modifiers GQ - Store-and-forward (asynchronous) 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). Unlisted, unspecified and nonspecific codes should be avoided. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. When no specific contracted rates are in place, Cigna will reimburse the administration of all covered COVID-19 vaccines at the established national CMS rates noted below when claims are billed under the medical benefit to ensure timely, consistent, and reasonable reimbursement. 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. Yes. Yes. UnitedHealthcare (UHC) is now requiring physicians to bill eligible telehealth services with place of service (POS) 02 for commercial products. 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. We maintain all current medical necessity review criteria for virtual care at this time. How Can You Tell Which Specific Technology is Reimbursable? Yes. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. DISCLAIMER: The contents of this database lack the force and effect of law, except as or As of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. We added a number of additional codes in March and April 2022 that are now eiligible for 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. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 Cost-share is waived only when billed by a provider or facility without any other codes. Excluded physician services may be billed Listing Results Cigna Telehealth Place Of Service. Unless your office was approved to be a facility to administer virtual patient care, then it is best to bill using the telehealth code (11) Office. Because health care providers are the most trusted source of information for consumers who are hesitant about receiving the vaccine, we continue to encourage providers to proactively educate their patients especially those who may have vaccine hesitancy or who are at high-risk of severe COVID-19 illness on the safety, effectiveness, and availability of the vaccine. Effective with January 1, 2021 dates of service, we implemented a new Virtual Care Reimbursement Policy. 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. Insurance Reimbursement Rates for Psychotherapy, Insurance Reimbursement Rates for Psychiatrists, Beginners Guide To Mental Health Billing, https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf, guide on HIPAA compliant video technology for telehealth, https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf, Inquire about our mental health insurance billing service, offload your mental health insurance billing, We charge a percentage of the allowed amount per paid claim (only paid claims). For details, see the CMS document titled Place of Service Codes for Professional Claims Database (updated September 2021). 31, 2022. In addition, the discharging provider or primary care physician can provide the post discharge visit virtually if appropriate. Yes. Please note that certain client exceptions may apply (e.g., clients may opt out of the treatment cost-share waiver or opt-in for an extension of the cost-share waiver). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. 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. TheraThink provides an affordable and incredibly easy solution. We will continue to monitor inpatient stays. Must be performed by a licensed provider. 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 Free Account Setup - we input your data at signup. No additional credentialing or notification to Cigna is required. 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 order to bill these codes, the test must be FDA approved or cleared or have received Emergency Use Authorization (EUA). While Cigna does not require any specific placement for COVID-19 diagnosis codes on a claim, we recommend providers include the COVID-19 diagnosis code for confirmed or suspected COVID-19 patients in the first position when the primary reason the patient is treated is to determine the presence of COVID-19. If a patient presents for services other than COVID-19, Cigna will waive cost-share only for the COVID-19 related services (e.g., laboratory test). However, providers are required to attest that their designated specialty meets the requirements of Cigna. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. 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. 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. 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. 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, U07.1, J12.82, M35.81, or M35.89 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnosis. Standard customer cost-share applies. 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. 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. Cigna does not reimburse an originating site of service fee or facility fee for telehealth visits, including for code Q3014, as they are not a covered benefit. Download and . website belongs to an official government organization in the United States. Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually until further notice. Services include methadone and other forms of Medication Assisted Treatment (MAT). **, Watch this short video to learn more about virtual care with MDLivefor Cigna.(Length: 00:01:33). 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. Please review our COVID-19 In Vitro Diagnostic Testing coverage policy for a list of additional services and ICD-10 codes that are generally not covered. 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. 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. Cigna follows CMS rules related to the use of modifiers. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. Yes. ), Preventive care services (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) [Effective with January 29, 2022 dates of service]. Please review the Virtual care services frequently asked questions section on this page for more information. Cost share is waived for all covered eConsults through December 31, 2021. 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. For more information, please visit Cigna.com/Coronavirus. Yes. April 14, 2021. 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. Providers who are administering the COVID-19 vaccine in a site other than their typical office or facility setting (e.g., at a sports complex) can bill us under their regular facility location. Providers should bill this code for dates of service on or after December 23, 2021. 24/7, live and on-demand for a variety of minor health care questions and concerns. 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. 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. Please know that we 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. 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. As of January 1, 2022, a new POS code has been approved to report more specifically where services were provided. We will also closely monitor and audit claims for inappropriate services that should not be performed virtually (including but not limited to: acupuncture, all surgical codes, anesthesia, radiology services, laboratory testing, administration of drugs and biologics, infusions or vaccines, and EEG or EKG testing). This includes: Please refer to the interim COVID-19 virtual care guidelines for a complete outline of our interim COVID-19 virtual care coverage. In addition, these requirements must be met: This guidance applies for all providers, including urgent care centers and emergency rooms, and applies to customers enrolled in Cigna's employer-sponsored plans in the United States and the Individual & Family plans available through the Affordable Care Act. BCBSNC Telehealth Corporate Reimbursement Policy CIGNA Humana Humana Telehealth Expansion 03/23/2020 Humana provider FAQs Medicaid Special Bulletin #28 03/30/2020 (Supersedes Special Bulletin #9) Medicare Telemedicine Provider Fact Sheet 03/17/2020 Medicare Waivers 03.30.2020 PalmettoGBA MLN Connects Special Edition - Tuesday, March 31, 2020 If an urgent care center performs an evaluation and treatment service, collects a specimen for COVID-19, and runs the laboratory test, they should bill just their per-visit S9083 code or just the laboratory code. 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. The Outbreak Period is a period distinct from the COVID-19 public health emergency (PHE), which applies to other COVID-related relief measures, such as no-cost share coverage of COVID-19 testing. Please note that some opt-outs for self-funded benefit plans may have applied. Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. Yes. Billing an evaluation and management (E/M) code when that level of service is not provided is fraudulent billing and is expressly prohibited. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. Activate your myCigna account nowto get access to a virtual dentist. When an order for home health services is clinically appropriate for telehealth services, the care will be offered through a virtual visit unless the order indicates that home health services must be in-person or the patient refuses the virtual visit. Location, distinct from a hospital emergency room, an office, or a clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention. Residential Substance Abuse Treatment Facility. For additional information about our Virtual Care Reimbursement Policy, providers can contact their provider representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). 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. All synchronous technology used must be secure and meet or exceed federal and state privacy requirements. 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. CMS officially has designated a Place of Service code for all of the telehealth to be "02" starting April 1, 2020. Toll Free Call Center: 1-877-696-6775. For all other IFP plans outside of Illinois, primary care physicians are still encouraged to coordinate care and assist in locating in-network specialists, but the plans no longer have referral requirements as of January 1, 2021. 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. 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 wanted to implement a policy that ensures you can continue to receive ongoing reimbursement for virtual care that you deliver to your patients with Cigna commercial medical coverage. Cigna Telehealth Place of Service Code: 02. A facility which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital. No. Yes. For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. No. In addition, it's my interpretation that Cigna is only paying for telehealth services for physical, occupational and speech therapy submitted on a 1500-claim form by a private practice. 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. Our national ancillary partner American Specialty Health (ASH) is applying the same virtual care guidance, so any provider participating through ASH and providing PT/OT services to Cigna customers is covered by the same guidance. 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. What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. Yes. We do not expect smaller laboratories or doctors' offices to be able to perform these tests. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. When the condition being billed is a post-COVID condition, please submit using ICD-10 code U09.9 and code first the specific condition related to COVID-19. Congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services. 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. A location which provides treatment for substance (alcohol and drug) abuse on an ambulatory basis. new codes. Note that billing B97.29 will not waive cost-share. Yes. U.S. Department of Health & Human Services They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. ), 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). Additional FDA EUA approved vaccines will be covered consistent with this guidance. Know how to bill a facility fee Claims must be submitted on a CMS-1500 form or electronic equivalent. It remains expected that the service billed is reasonable to be provided in a virtual setting. Last updated February 15, 2023 - Highlighted text indicates updates. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. Prior authorization for treatment follows the same protocol as any other illness based on place of service and according to plan coverage. 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. The .gov means its official. When a state allows an emergent temporary provider licensure, Cigna will allow providers to practice in that state as participating if a provider is already participating with Cigna, is in "good standing," and if state regulations allow such care to take place. No. No. Effective January 1, 2021, we implemented a new. 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 . In addition, Anthem would recognize telephonic-only . Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. Important notes: For additional information about Cigna's coverage of medically necessary diagnostic COVID-19 tests, please review the COVID-19 In Vitro Diagnostic Testing coverage policy. 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. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. Cigna will determine coverage for each test based on the specific code(s) the provider bills. You get connected quickly. In such cases, we will review the services provided on appeal for medical necessity to determine appropriate coverage.As a reminder, precertification is not required for the evaluation, testing, or medically necessary treatment of Cigna customers related to COVID-19. MLN Matters article MM7631, Revised and clarified place of service (POS) coding instructions. No. Total 0 Results. 1 Please note that while virtual care services billed on a UB-04 claim will not typically be reimbursed under this policy, we continue to reimburse virtual care services billed on a UB-04 claim form until further notice as a COVID-19 accommodation when the services: Please note that existing reimbursement policies will apply and may affect claims payment (e.g., R30 E&M Services). Yes. 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]).