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. (Effective January 1, 2020). The ordering provider should use the standard, existing process to submit home health orders to eviCore healthcare. 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). 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. For costs and details of coverage, review your plan documents or contact a Cigna representative. It's convenient, not costly. 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. What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? If the individual COVID-19 related diagnostic test(s) are included in a laboratory panel code, only the code for the panel test will be reimbursed. Schedule an appointment online with MDLIVE and visit a lab for your blood work and biometrics. We recommend providers bill POS 02 beginning July 1, 2022 for virtual services (instead of a face-to-face POS). The site is secure. These include: Virtual preventive care, routine care, and specialist referrals. Yes. Non-contracted providers should use the Place of Service code they would have used had the . 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. These codes should be used on professional claims to specify the entity where service (s) were rendered. 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. All Cigna pharmacy and medical plans will cover Paxlovid and molnupiravir at any pharmacy or doctors office (in- or out-of-network) that has them available. Cigna allows modifiers GQ, GT, or 95 to indicate virtual care for all services. For more information about current Evernorth Behavioral Health virtual care guidance, please visit CignaforHCP.com > Resources > Behavioral Resources > Doing Business with Cigna >, For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com >, Outpatient E&M codes for new and established patients (99202-99215), Physical and occupational therapy E&M codes (97161-97168), Annual wellness visit codes (G0438 and G0439), Services must be on the list of eligible codes contained within in our. There may be limited exclusions based on the diagnoses submitted. Cigna will generally not cover molecular, antigen, or antibody tests for asymptomatic individuals 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 commercial and Cigna Medicare Advantage customers receive the COVID-19 vaccine with no out-of-pocket costs; and. This is an extenuating circumstance. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. 2. You can call, text, or email us about any claim, anytime, and hear back that day. (Effective January 1, 2016). These codes are used to report episodes of patient care initiated by an established patient or guardian of an established patient. Anthem would recognize IOP services that are rendered via telehealth with a revenue code (905, 906, 912, 913), plus CPT codes for specific behavioral health services. No additional credentialing or notification to Cigna is required. 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. Therefore, FaceTime, Skype, Zoom, etc. New/Modifications to the Place of Service (POS) Codes for Telehealth. Cigna will determine coverage for each test based on the specific code(s) the provider bills. 4 Due to state laws governing teledentistry, this service is not available to residents of Texas. This code will only be covered where state mandates require it. We will continue to assess the situation and adjust to market needs as necessary. 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. As of June 1, 2021, these plans again require referrals. We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. For other laboratory tests when COVID-19 may be suspected. 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. 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. For dates of service February 4, 2020 through February 15, 2021, Cigna covered COVID-19 treatments without customer cost-share. Yes. 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. No waiting rooms. All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02. A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients. Standard cost-share will apply for the customer, unless waived by state-specific requirements. for services delivered via telehealth. Excluded physician services may be billed Secure .gov websites use HTTPSA 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. However, Cigna will still consider requestes for accelerated credentialing on a case-by-case basis. Note: This article was updated on January 26, 2022, for clarification purposes. The patient may be either a new patient to the consultant or an established patient with a new problem or an exacerbation of an existing problem. No. 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. Certain home health services can be provided virtually using synchronous communication as part of our R31 Virtual Care Reimbursement Policy. ** The Benefits of Virtual Care No waiting rooms. representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). If you are looking for more comprehensive implementation . 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. When no specific contracted rates are in place, Cigna will reimburse covered services at the established national CMS rates to ensure timely, consistent, and reasonable reimbursement. Residential Substance Abuse Treatment Facility. 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. 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. State and federal mandates, as well as customer benefit plan designs, may supersede our guidelines. Diluents are not separately reimbursable in addition to the administration code for the infusion. On January 1, 2021, we implemented a Virtual Care Reimbursement Policy that ensures permanent coverage of certain virtual care services. Washington, D.C. 20201 We are awaiting further billing instructions for providers, as applicable, from CMS. Maybe. Refer to the Telemedicine Website for a list of billing codes which may be used with Place of Service (POS) 02 or 10. The codes may only be billed once in a seven day time period. 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). Listed below are place of service codes and descriptions. 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. 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. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. Treatment is supportive only and focused on symptom relief. We will continue to monitor inpatient stays. In 2017, Cigna launched behavioral telehealth sessions for all their members. Providers will not need a specific consent from patients to conduct eConsults. 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. No. Yes. A federal government website managed by the 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 . 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. The Center for Medicare and Medicaid Services (CMS) has announced that there is to be a change in the telehealth place of service (POS) code for billing Medicare and Medicaid Services. Please review these changes by going to the Provider FastFax page and selecting fax number 30. 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. The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place at least until the end of Public Health Emergency (PHE) period. If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice. 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). A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided. Please visit CignaforHCP.com/virtualcare for additional information about that policy. Services performed on and after March 1, 2023 would have just their standard timely filing window. We continue to make several other accommodations related to virtual care until further notice. Considering the pressure facilities are under, Cigna will extend the authorization approval window from three months to six months on request. You free me to focus on the work I love!. The location where health services and health related services are provided or received, through telecommunication technology. (Receive an extra 25% off with payment made by Mastercard.) You get connected quickly. Cost share is waived for all covered eConsults through December 31, 2021. 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. 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. 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. When specific contracted rates are in place for COVID-19 vaccine administration services, Cigna will reimburse covered services at those contracted rates. Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. It must be initiated by the patient and not a prior scheduled visit. Free Account Setup - we input your data at signup. Yes. Unless telehealth requirements are . No. 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. 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 . While we will reimburse these services consistent with face-to-face rates, we will monitor the use of level four and five services to limit fraud, waste, and abuse. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. 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. Telephone codes were added to the list of services that can be billed via telehealth, and the rates for codes 99441-99443 were increased, to match the rates for 99212-99214 Office visit codes must still use two-way audio and visual, real time interactive technologies, but the payment rates for audio only codes (99441-99443) were increased While services billed on a UB-04 are out of scope for the new policy, we will continue to evaluate facility-based services for future policy updates. mitchellde True Blue Messages 13,505 Location Columbia, MO Best answers 2 Mar 9, 2020 #2 Those are the codes for a phone visit. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. 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. Providers receive reasonable reimbursement consistent with national CMS rates for administering EUA-approved COVID-19 vaccines. A facility maintained by either State or local health departments that provides ambulatory primary medical care under the general direction of a physician. Let us handle handle your insurance billing so you can focus on your practice. In these cases, the non-credentialed provider can bill under the group assuming they are practicing within state laws to administer the vaccine. Cost-share is waived only when providers bill one of the identified codes. An official website of the United States government No additional modifiers are necessary. Yes. All synchronous technology used must be secure and meet or exceed federal and state privacy requirements. or Neither U0003 nor U0004 should be used for tests that are used to detect COVID-19 antibodies. 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. The Department may not cite, use, or rely on any guidance that is not posted My cost is a percentage of what is insurance-approved and its my favorite bill to pay each month! Effective January 1, 2021, we implemented a new. ICD-10 diagnosis codes that generally reflect non-covered services are as follows. For COVID-19 related screening (i.e., quick phone or video consult): No cost-share for customers through at least, For non-COVID-19 related services (e.g., oncology visit, routine follow-up care): Standard customer cost-share. 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. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. 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. 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. Issued by: Centers for Medicare & Medicaid Services (CMS). 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. This guidance applies to all providers, including laboratories. PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. 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. We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information. Cigna covers FDA EUA-approved laboratory tests. 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. 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) In compliance with federal agency guidance, however, Cigna covers individualized COVID-19 diagnostic tests without cost-share through at least May 11, 2023 for asymptomatic individuals when referred by or administered by a health care provider. We are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. No. A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. A facility whose primary purpose is education. website belongs to an official government organization in the United States. 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 Customers will be referred to seek in-person care. 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. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. Medicare telehealth services practitioners use "02" if the telehealth service is delivered anywhere except for the patient's home. We do not expect smaller laboratories or doctors' offices to be able to perform these tests. Cigna did not make any requirements regarding the type of technology used for virtual care through December 31, 2020 (i.e., phone, video, FaceTime, Skype, etc. 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. This generally takes place in a mass immunization setting, such as, a public health center, pharmacy, or mall but may include a physician office setting. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. The White House announced the intent to end both the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023. All Rights Reserved. POS 11, 19 and 22) modifier GT or 95 (or GQ for Medicaid) must be used. Yes. We also referenced the current list of covered virtual care codes by the CMS to help inform our coverage strategy. 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. Please review the Virtual Care Reimbursement Policy for additional details on the added codes. Providers will continue to be reimbursed at 100% of their face-to-face rates for covered virtual care services, even when billing POS 02. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. Diagnoses requiring testing cannot be confirmed. Yes. .gov Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. Emergent transport to nearby facilities capable of treating customers is covered without prior authorization. Cigna will reimburse at 100% of face-to-face rates, even when billing POS 02. If a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. Cigna Telehealth Place of Service Code: 02. If the patient is in their home, use "10". Please review the Virtual care services frequently asked questions section on this page for more information. Cigna continues to require prior authorization reviews for routine advanced imaging. 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). Yes. means youve safely connected to the .gov website. A facility other than a hospital, which provides dialysis treatment, maintenance, and/or training to patients or caregivers on an ambulatory or home-care basis. When a claim is submitted by the facility the patient was transferred to (e.g., SNF, AR, or LTACH), the facility should note that the patient was transferred to them without an authorization in an effort to quickly to free up bed space for the transferring facility. Transport between facilities such as hospitals and SNFs and hospitals and Acute Rehab centers is also covered without prior authorization. Bill those services on a CMS-1500 form or electronic equivalent. We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice. Yes. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. For dates of service April 1 - June 30, 2022, Cigna will apply a 1% payment adjustment. 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). No. Learn about the medical, dental, pharmacy, behavioral, and voluntary benefits your employer may offer. 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. Once completed, telehealth will be added to your Cigna specialty. No. Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours. Important notes, What the accepting facility should know and do. The accelerated credentialing accommodation ended on June 30, 2022. We will also continue to consider Centers for Medicare & Medicaid (CMS) guidance, industry standards, and affordability for our clients to help inform any potential future changes to our reimbursement approach. Audio-only encounters can be provided using the telephone evaluation and management codes (CPT codes. No.