Urgent care centers can also bill their typical S9083 code for services that are more complex than a quick telephone call. This guidance applies to all providers, including laboratories. However, we believe that FDA and EUA-approved vaccines are safe and effective, and encourage our customers to get vaccinated. Please review the Virtual care services frequently asked questions section on this page for more information. State and federal mandates, as well as customer benefit plan designs, may supersede our guidelines. Patient is not located in their home when receiving health services or health related services through telecommunication technology. When specific contracted rates are in place for COVID-19 specimen collection services, Cigna will reimburse covered services at those contracted rates. Please note that we continue to request that providers do not bill with modifiers 93 or FQ at this time. Per usual protocol, emergency and inpatient imaging services do not require prior authorization. A facility which provides room, board and other personal assistance services, generally on a long-term basis, and which does not include a medical component. 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). Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. 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. Locations may have included hospitals, rehabilitation centers, skilled nursing facilities, temporary hospitals, or any other facility where treatment is generally provided. No. More information about coronavirus waivers and flexibilities is available on . Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. ** The Benefits of Virtual Care No waiting rooms. Treatment is supportive only and focused on symptom relief. 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. Because most standard Cigna client benefit plans do not extend coverage to screening services when performed for employment reasons (e.g., occupational physical examination), virtual care screening services will generally not be covered solely for return-to-work purposes. However, CMS published additional details about their new initiative to cover FDA approved, authorized, or cleared over-the-counter (OTC) COVID-19 tests at no cost. 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. The ICD-10 codes for the reason of the encounter should be billed in the primary position. 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. A facility, other than a hospital's maternity facilities or a physician's office, which provides a setting for labor, delivery, and immediate post-partum care as well as immediate care of new born infants. 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. Note that high-throughput tests may only be run in a high-complexity laboratory; The laboratory or provider bills using the codes in our interim billing guidelines and. Official websites use .govA 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. The accelerated credentialing accommodation ended on June 30, 2022. Let us handle handle your insurance billing so you can focus on your practice. Ultimately however, care must be medically necessary to be covered. Cigna covered the administration and post-administration monitoring of EUA-approved COVID-19 infusion treatments with no customer-cost share for services provided through February 15, 2021. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. As of July 1, 2022, standard credentialing timelines again apply. Most mental health providers will be furnishing services using Place of Service code 10 (POS 10) when providing telehealth services. A location where providers administer pneumococcal pneumonia and influenza virus vaccinations and submit these services as electronic media claims, paper claims, or using the roster billing method. As always, we remain committed to ensuring that: Yes. Diagnoses requiring testing cannot be confirmed. 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. When a customer receives virtual care services from their regular doctor (or any other provider) as part of this policy and when the provider bills with POS 02 customers with certain benefit plans may have a lower cost-share. They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice. 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. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. 4. TheraThink.com 2023. A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided. 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. For additional information about our Virtual Care Reimbursement Policy, please review the policy, contact your provider representative, or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). Cigna offers a number of virtual care options depending on your plan. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. New telehealth POS A new place of service (POS) code will go into effect Jan. 1, 2022, but Medicare doesn't plan on using it. For example, if the Outbreak Period ends March 1, 2023, any service performed on or before that date will have its standard timely filing window begin upon the expiration of the Outbreak Period (here, March 1, 2023). Prior authorization for treatment follows the same protocol as any other illness based on place of service and according to plan coverage. For more information, including details on how you can get reimbursed for these tests from original Medicare when you directly supply them to your patients with Part B or Medicare Advantage plans, please, U0003: $75 per test (high-throughput PCR-based coronavirus test)*, U0004: $75 per test (any technique with high-throughput technology)*, U0005: $25 (when test results are returned within two days)*, Routine and/or executive physicals (Z02.89). This is a key difference between Commercial and Medicare risk . Emergent transport to nearby facilities capable of treating customers is covered without prior authorization. Audio -only CPT codes 98966 98968 and 99441 We continue to make several other accommodations related to virtual care until further notice. 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. INTERIM TELEHEALTH GUIDANCE Announcement from Cigna Behavioral Health . What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? To this end, we will use all feedback we receive to consider further updates to our policy. 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). Neither U0003 nor U0004 should be used for tests that are used to detect COVID-19 antibodies. These include: Virtual preventive care, routine care, and specialist referrals. In 2017, Cigna launched behavioral telehealth sessions for all their members. MLN Matters article MM12427, New modifications to place of service (POS) codes for telehealth. For dates of service April 14, 2020 through at least May 11, 2023, Cigna will cover U0003 and U0004 with no customer cost-share when billed by laboratories using high-throughput technologies as described by CMS. 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. How Can You Tell Which Specific Technology is Reimbursable? We understand that it's important to actually be able to speak to someone about your billing. For more information, please visit Cigna.com/Coronavirus. The Administration's plan is to end the COVID-19 public health emergency (PHE) on May 11, 2023. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. My cost is a percentage of what is insurance-approved and its my favorite bill to pay each month! There may be limited exclusions based on the diagnoses submitted. Please visit. A facility which primarily provides to residents skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care services above the level of custodial care to other than individuals with intellectual disabilities. 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. Cigna will allow reimbursement for these codes by any provider or facility only when billed without any other codes (except where the contract allows it). Similar to non-diagnostic COVID-19 testing services, Cigna will only cover non-diagnostic return-to-work virtual care services when covered by the client benefit plan. This form can be completed here:https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf. Yes. .gov The ordering provider should use the standard, existing process to submit home health orders to eviCore healthcare. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. We are committed to helping providers deliver care how, when, and where it best meets the needs of their patients. Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. For example, talking to a board-certified doctor for a minor medical issue costs less than an ER or urgent care center, and may even be less than an in-office Primary Care Provider (PCP) visit. As of June 1, 2021, these plans again require referrals. This means that providers could perform services for commercial Cigna medical customers in a virtual setting and bill as though the services were performed face-to-face. Claims were not denied due to lack of referrals for these services during that time. We added a number of additional codes in March and April 2022 that are now eiligible for reimbursement. 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. For dates of service April 1 - June 30, 2022, Cigna will apply a 1% payment adjustment. Therefore, effective with August 15 dates of service, Cigna will reimburse providers consistent with CMS rates for doses of bebtelovimab that they purchase directly from the manufacturer. One of our key goals is to help your patients connect to affordable, predictable, and convenient care anytime, anywhere. No. Summary of Codes for Use During State of Emergency. Cigna will factor in the current strain on health care systems and will incorporate this information into retrospective reviews. Cigna follows CMS rules related to the use of modifiers. Download and . 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. All health insurance policies and health benefit plans contain exclusions and limitations. Please note that customer cost-share and out-of-pocket costs may vary for services customers receive through our virtual care vendor network (e.g., MDLive). Free Account Setup - we input your data at signup. Must be performed by a licensed provider. This will help with tracking purposes, and ensure timely reimbursement for the administration of the treatment. 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. 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. Yes. This new initiative enables payment from original Medicare for submitted claims directly to participating eligible pharmacies and other health care providers, which allows Medicare beneficiaries to receive tests at no cost. Yes. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing. Cigna continues to require prior authorization reviews for routine advanced imaging. A federal government website managed by the 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. 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. (As of 01/21/2021) What Common Procedural Technology (CPT) codes should be used for COVID-19 testing? Providers should bill one of the above codes, along with: No. mitchellde True Blue Messages 13,505 Location Columbia, MO Best answers 2 Mar 9, 2020 #2 Those are the codes for a phone visit. And as your patients seek more convenient and safe care options, we continue to see growing interest in virtual care (i.e., telehealth) especially from consumers and their providers who want to ensure they have greater access and connection to each other. 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. Services provided on and after February 16, 2021 remain covered, but with standard customer cost-share.After the EUA or licensure of each COVID-19 treatment by the FDA, CMS will identify the specific drug code(s) along with the specific administration code(s) for each drug that should be billed. For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. Certain PT, OT, and ST virtual care services remain reimbursable under the R31 Virtual Care Reimbursement Policy. Issued by: Centers for Medicare & Medicaid Services (CMS). The Department may not cite, use, or rely on any guidance that is not posted This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. 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. Cigna covers pre-admission and pre-surgical COVID-19 testing with no customer cost-share when performed in an outpatient setting through at least May 11, 2023. 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. Per CMS, U0003 and U0004 should be used to bill for tests that would typically be billed by 87635 and U0002 respectively, except for when the tests are performed with these high-throughput technologies. 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. To sign up for updates or to access your subscriber preferences, please enter your contact information below. Providers will continue to be reimbursed at 100% of their face-to-face rates for covered virtual care services, even when billing POS 02. We hope you join us in our journey to offer our customers increased access to virtual care and appreciate your commitment to work with us as our virtual care platform continues to evolve to the meet the needs of our providers, customers, and clients. All synchronous technology used must be secure and meet or exceed federal and state privacy requirements. While we encourage PT/OT/ST providers to follow CMS guidance regarding the use of software programs for virtual care, we are not requiring the use of any specific software program at this time. You free me to focus on the work I love!. and the home vaccine administration code (M0201) on the same claim under the medical benefit.When specific contracted rates are in place for vaccine administration services, Cigna will reimburse covered services at those contracted rates. website belongs to an official government organization in the United States. 3. 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. a listing of the legal entities Cigna will determine coverage for each test based on the specific code(s) the provider bills. 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 the purposes of private practice, the three most common service codes therapists are likely to bill are "11" (office), "12" (in-home services), and "2" (telehealth). Deliver services that are covered by the Virtual Care Reimbursement Policy; Bill consistently with the requirements of the policy; and. 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. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF). * POS code 10 POS code name No additional modifiers are necessary to include on the claim. Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually until further notice. Cigna will accept roster billing from providers who are already mass immunizers and bill Cigna today in this way for other vaccines (e.g., seasonal flu vaccine), as well as from providers and state agencies that are offering mass vaccinations for their local communities, provided the claim roster includes sufficient information to identify the Cigna customer. Please review the "Virtual care services" frequently asked questions section on this page for more information. 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. 2. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). Learn about the medical, dental, pharmacy, behavioral, and voluntary benefits your employer may offer. 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. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. 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. 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. Bill those services on a CMS-1500 form or electronic equivalent. April 14, 2021. Billing for telehealth nutrition services may vary based on the insurance provider. Standard cost-share will apply for the customer, unless waived by state-specific requirements. For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02. Yes. 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. Yes. 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. 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. Listed below are place of service codes and descriptions. 24/7, live and on-demand for a variety of minor health care questions and concerns. 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. Is there a code that we can use to bill for this other than 99441-99443? Cigna will only cover non-diagnostic PCR, antigen, and serology (i.e., antibody) tests when covered by the client benefit plan. 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. When no specific contracted rates are in place, providers will be reimbursed $40 per dose for general vaccine administration and an additional $35.50 per dose for administering it in a home setting for total reimbursement of $75.50 per vaccine dose. Cigna has not lifted precertification requirements for scheduled surgeries. Throughout the pandemic, the emergency use authorized monoclonal antibody drug bebtelovimab was purchased by the federal government and offered to providers for free. 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. 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). No additional modifiers are necessary. 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. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. No virtual care modifier is needed given that the code defines the service as an eConsult. eConsult services remain covered; however, customer cost-share applies as of January 1, 2022. Cigna does not provide additional reimbursement for PPE-related costs, including supplies, materials, and additional staff time (e.g., CPT codes 99072 and S8301), as office visit (E&M) codes include overhead expenses, such as necessary PPE. This policy applied to customers in the United States who are covered under Cigna's employer/union sponsored insured group health plans, insured plans for US-based globally mobile individuals, Medicare Advantage, and Individual and Family Plans (IFP). 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. However, providers are required to attest that their designated specialty meets the requirements of Cigna. Effective January 1, 2022, eConsults remain covered, but cost-share applies for all covered services. Cigna allows modifiers GQ, GT, or 95 to indicate virtual care for all services. lock When specific contracted rates are in place for COVID-19 vaccine administration services, Cigna will reimburse covered services at those contracted rates. 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. A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician's office. 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. 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. bill a typical face-to-face place of service (e.g., POS 11) . 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) 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. Once completed, telehealth will be added to your Cigna specialty. The 02 Place of Service code will automatically populate onto your courtesy claims and Superbills when the appointment is scheduled at that location. (Effective January 1, 2020). 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 . No. 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. Medicare telehealth services practitioners use "02" if the telehealth service is delivered anywhere except for the patient's home. 1. Speak with a provider online and discuss your lab work, biometric screenings.