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. that insure or administer group HMO, dental HMO, and other products or services in your state). 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. 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. 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. For more information, see the resources along the right-hand side of the screen. 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. You can call, text, or email us about any claim, anytime, and hear back that day. 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. On Aug. 3, 2020 CMS published a revision to the April 27th, 2020 memo announcing the addition of telephonic CPT codes (98966-98968, 99441-99443) valid for 2020 benefit year data submissions for the Department of Health and Human Services- (HHS-) operated risk adjustment program. A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology. Mid-level practitioners (e.g., physician assistants and nurse practitioners) can also provide services virtually using the same guidance. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. Yes. 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. 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. TheraThink.com 2023. Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. Listed below are place of service codes and descriptions. Other place of service not identified above. Cigna will only cover non-diagnostic PCR, antigen, and serology (i.e., antibody) tests when covered by the client benefit plan. Specialist to specialist (e.g., ophthalmologist requesting consultation from a retina specialist, orthopedic surgeon requesting consultation from an orthopedic surgeon oncologist, cardiologist with an electrophysiology cardiologist, and obstetrician from a maternal fetal medicine specialist), Hospitalist requests an infectious disease consultation for pulmonary infections to guide antibiotic therapy, The ICD-10 code that represents the primary condition, symptom, or diagnosis as the purpose of the consult; and. POS 02: Telehealth Provided Other than in Patient's Home 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 Cigna continues to reimburse participating providers when they are credentialed to practice medicine per state regulations, have a current contract, and have completed the Cigna credentialing process.Non-participating providers will only be reimbursed if: Yes. Yes. (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.). (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). Instead, we request that providers bill POS 02 for all virtual care in support of the new client benefit plan option that lowers cost-share for certain customers who receive virtual care. When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance. Cigna follows CMS rules related to the use of modifiers. 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. 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 No. means youve safely connected to the .gov website. 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. Please note that this list is not all inclusive and may not represent an exact indication match. As of April 1, 2021, Cigna resumed standard authorization requirements. What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. POS 10 Telehealth provided in a patient's home was created for services provided remotely to a patient in their private residence. Approximately 98% of reviews are completed within two business days of submission. Locations may have included hospitals, rehabilitation centers, skilled nursing facilities, temporary hospitals, or any other facility where treatment is generally provided. A facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters). Learn about the medical, dental, pharmacy, behavioral, and voluntary benefits your employer may offer. No. 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. 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. We are your billing staff here to help. Clarifying Codes G0463 and Q3014 Unfortunately, this policy also created a great deal of confusion and inconsistency among providers regarding which code to bill when providing remote clinic visits: G0463, Hospital outpatient clinic visit for assessment and management of a patient, or Q3014, Telehealth originating site facility fee. Per CMS, individuals without health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost. Listed below are place of service codes and descriptions. There may be limited exclusions based on the diagnoses submitted. No. However, this added functionality is planned for a future update. Customer cost-share will be waived for COVID-19 related virtual care services through at least. 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. 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. Talk privately with a licensed therapist or psychiatrist by appointment using your phone, tablet, or computer. Yes. Emotional health resources have been added to the COVID-19 interim guidance page for behavioral providers at CignaforHCP.com. 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. Providers can, however, bill the vaccine code (e.g., 91300 for the Pfizer vaccine or 91301 for the Moderna vaccine) with a nominal charge (e.g., $.01), but it is not required to be billed in order to receive reimbursement for the administration of the vaccine. When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance. Please note that if the only service rendered is a specimen collection and/or testing, and all of the required components for an evaluation and management (E/M) service code are not met, then only the code for the specimen collection or testing should be billed. This includes providers who typically deliver services in a facility setting. We are actively reviewing all COVID-19 state mandates and will continue to share any changes and more details around coverage, reimbursement, and cost-share as applicable. Generally, only well-equipped commercial laboratories and hospital-based laboratories will have the necessary equipment to offer these tests. 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. Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. 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). COVID-19 OTC tests used for employment, travel, participation in sports or other activities are not covered under this mandate. Cigna commercial and Cigna Medicare Advantage are waiving the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. More information about coronavirus waivers and flexibilities is available on . Unlisted, unspecified and nonspecific codes should be avoided. The interim COVID-19 virtual care guidelines as outlined on this page were in place for dates of service through December 31, 2020. It's convenient, not costly. 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. Primary care physician to specialist requesting input from a cardiologist, psychiatrist, pulmonologist, allergist, dermatologist, surgeon, oncologist, etc. As of July 1, 2022, we request that providers bill with POS 02 for all virtual care. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. Providers billing under an 837P/1500 must include the place of service (POS) code 02 when submitting claims for services delivered via telehealth. Cost share is waived for all covered eConsults through December 31, 2021. A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders. 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 . new codes. Thank you. 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. 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. First Page. 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. (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. The accelerated credentialing accommodation ended on June 30, 2022. website belongs to an official government organization in the United States. 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. 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. 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 or pharmacy. 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. While the policy - announced in United's . Comprehensive Outpatient Rehabilitation Facility. 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. 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. The ICD-10 codes for the reason of the encounter should be billed in the primary position. This form can be completed here:https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf. 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. The covered procedure codes for E-visits/online portal services include: 99421, 99422, 99423, G2061, G2062, G2063. PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. Cigna will waive all customer cost-share for diagnostic services, testing, and treatment related to COVID-19, as follows: The visit will be covered without customer cost-share if the provider determines that the visit was consistent with COVID-19 diagnostic purposes. No authorization is required for the procurement or administration of COVID-19 infusion treatments. No. (99441, 98966, 99442, 98967, 99334, 98968). A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. Billing the appropriate administration code will ensure that cost-share is waived. A facility which primarily provides health-related care and services above the level of custodial care to individuals but does not provide the level of care or treatment available in a hospital or SNF. These codes are used to report episodes of patient care initiated by an established patient or guardian of an established patient. 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. In addition, the discharging provider or primary care physician can provide the post discharge visit virtually if appropriate. 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. No. We also continue to make several additional accommodations related to virtual care until further notice. 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. No. Services not related to COVID-19 will have standard customer cost-share. COVID-19 admissions would be emergent admissions and do not require prior authorizations. Coverage reviews for appropriate levels of care and medical necessity will still apply. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. 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. I cannot capture in words the value to me of TheraThink. Talk to board-certified dermatologists without an appointment for customized care for skin, hair, and nail conditions. If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice. Yes. An E&M service and COVID-19 vaccine administration code should only be billed when a significant and separately identifiable E&M visit was performed at the same time as the administration of the vaccine. 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. Reimbursement for codes that are typically billed include: Yes. 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 Reimbursement, when no specific contracted rates are in place, are as follows: No. No. My cost is a percentage of what is insurance-approved and its my favorite bill to pay each month! 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). 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). Speak with a provider online and discuss your lab work, biometric screenings. 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. How Can You Tell Which Specific Technology is Reimbursable? 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 MLN Matters article MM12549, CY2022 telehealth update Medicare physician fee schedule. A facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program for patients who do not require full time hospitalization, but who need broader programs than are possible from outpatient visits to a hospital-based or hospital-affiliated facility.