Services not related to COVID-19 will have standard customer cost-share. Please visit. 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 Place of Service 02 in Field 24-B (see sample claim form below) For illustrative purposes only. Yes. Non-contracted providers should use the Place of Service code they would have used had the . 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. If you are looking for more comprehensive implementation . When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. No. The COVID-19 billing and reimbursement guidelines that follow are for commercial Cigna medical services, including IFP, unless otherwise noted. We will continue to monitor inpatient stays. Yes. Specimen collection centers like these can also bill codes G2023 or G2024 following the preceding guidance. Cigna allows modifiers GQ, GT, or 95 to indicate virtual care for all services. Yes. For telehealth, the 95 modifier code is used as well. U.S. Department of Health & Human Services When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9. Therefore, to increase convenient 24/7 access to care if a customers preferred provider is unavailable in-person or virtually, covered virtual care is also available through national virtual care vendors like MDLive. 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. codes and normal billing procedures. Yes. No. 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. No. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. 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. Last updated February 15, 2023 - Highlighted text indicates updates. 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). (Description change effective January 1, 2016). Additional information about the COVID-19 vaccines, including planning for a vaccine, vaccine development, getting vaccinated, and vaccine safety can be found on the CDC website. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. Reimbursement will be consistent as though they performed the service in a face-to-face setting. Yes. My cost is a percentage of what is insurance-approved and its my favorite bill to pay each month! Services include physical therapy, occupational therapy, and speech pathology services. Unlisted, unspecified and nonspecific codes should be avoided. 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. 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. Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. No. https:// Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. Cigna covers Remdesivir for the treatment of COVID-19 when administered in inpatient or outpatient settings consistent with EUA usage guidelines and Cigna's Drug and Biologic Coverage Policy. Generally, only well-equipped commercial laboratories and hospital-based laboratories will have the necessary equipment to offer these tests. On January 1, 2021, we implemented a Virtual Care Reimbursement Policy that ensures permanent coverage of certain virtual care services. Service codes Physicians: use service codes 99441-99443; Non-physicians: use 98966-98968 We're waiving copays for telehealth visits for behavioral and mental health counseling for members eligible for managed long-term services and supports (MLTSS) and Division of Developmental . No waiting rooms. Our policy allows for reimbursement of a variety of services typically performed in an office setting that are appropriate to also perform virtually. No. Yes. 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. As of July 1, 2022, standard credentialing timelines again apply. 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. Deliver services that are covered by the Virtual Care Reimbursement Policy; Bill consistently with the requirements of the policy; and. Talk privately with a licensed therapist or psychiatrist by appointment using your phone, tablet, or computer. Inpatient COVID-19 care that began on or before February 15, 2021, and continued after February 16, 2021, will have cost-share waived for the entire course of the facility stay. 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. A facility that provides the following services: outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically ill, and residents of the CMHC's mental health services area who have been discharged from inpatient treatment at a mental health facility; 24 hour a day emergency care services; day treatment, other partial hospitalization services, or psychosocial rehabilitation services; screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission; and consultation and education services. As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. New/Modifications to the Place of Service (POS) Codes for Telehealth. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. 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. This coverage began January 15, 2022 and continues through at least the end of the public health emergency (PHE) period (May 11, 2023). 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 What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? Please review the Virtual Care Reimbursement Policy for additional details on the added codes. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. Thanks for your help! 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. 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. Free Account Setup - we input your data at signup. Bill those services on a CMS-1500 form or electronic equivalent. This will help us to meet customers' clinical needs and support safe discharge planning. 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 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). Note that billing B97.29 will not waive cost-share. A portion of a hospitals main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. To increase convenient 24/7 access to care if a patients preferred provider is unavailable in-person or virtually, our virtual care platform also offers solutions that include national virtual care vendors like MDLive. Cigna will reimburse at 100% of face-to-face rates, even when billing POS 02. We also continue to make several additional accommodations related to virtual care until further notice. Billing an evaluation and management (E/M) code when that level of service is not provided is fraudulent billing and is expressly prohibited. In certain cases, yes. 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. 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 In 2017, Cigna launched behavioral telehealth sessions for all their members. If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice. The covered procedure codes for E-visits/online portal services include: 99421, 99422, 99423, G2061, G2062, G2063. We understand that it's important to actually be able to speak to someone about your billing. No. As private practitioners, our clinical work alone is full-time. While virtual care provided by an urgent care center is not covered per our R31 Virtual Care Reimbursement Policy, we continue to reimburse urgent care centers for delivering virtual care until further notice as part of our interim COVID-19 virtual care accommodations. 1 In an emergency, always dial 911 or visit the nearest hospital. Claims were not denied due to lack of referrals for these services during that time. Yes. This includes when done by any provider at any site, including an emergency room, free-standing emergency room, urgent care center, other outpatient setting, physicians office, etc. 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. As always, we remain committed to providing further updates as soon as they become available. First Page. Yes. New/Modifications to the Place of Service (POS) Codes for Telehealth This Change Request implements a new POS code (10) for Telehealth, as well as modifies the description for the existing POS code (02) for Telehealth. Cigna commercial and Cigna Medicare Advantage are waiving the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. 2 Limited to labs contracted with MDLIVE for virtual wellness screenings. 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. 1995-2020 by the American Academy of Orthopaedic Surgeons. 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. Before sharing sensitive information, make sure youre on a federal government site. Cigna may request the appropriate CLIA-certification or waiver as well as the manufacturer and name of the test being performed. We continue to make several other accommodations related to virtual care until further notice. Location, other than a hospital or other facility, where the patient receives care in a private residence. 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. Cigna ultimately looks to the FDA, CDC, and ACIP to determine these factors. We will continue to assess the situation and adjust to market needs as necessary. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. We are awaiting further billing instructions for providers, as applicable, from CMS. 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. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). Yes. In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. 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. (This code is available for use immediately with a final effective date of May 1, 2010), A location, not described by any other POS code, owned or operated by a public or private entity where the patient is employed, and where a health professional provides on-going or episodic occupational medical, therapeutic or rehabilitative services to the individual. M misstigris Networker Messages 63 Location Portland, OR For telehealth services rendered by a facility provider, report the CPT/HCPCS code with the applicable revenue code as would normally be done for an in-person visit, and also append either modifier 95 or GT. All other customers will have the same cost-share as if they received the services in-person from that same provider. POS 02: Telehealth Provided Other than in Patient's Home Sign up to get the latest information about your choice of CMS topics. 31, 2022. Cigna does not require prior authorization for home health services. A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients. Hi Laelia, I'd be happy to help. Providers will not need a specific consent from patients to conduct eConsults. INTERIM TELEHEALTH GUIDANCE Announcement from Cigna Behavioral Health . 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. Cigna will determine coverage for each test based on the specific code(s) the provider bills. 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 facility maintained by either State or local health departments that provides ambulatory primary medical care under the general direction of a physician. Psychiatric Facility-Partial Hospitalization. These codes should be used on professional claims to specify the entity where service(s) were rendered. or Emergent transport to nearby facilities capable of treating customers is covered without prior authorization. When billing for the service, indicate the place of service as where the visit would have occurred if in person. Denny and his team are responsive, incredibly easy to work with, and know their stuff. For all Optum Behavioral Health commercial plans, any telehealth services provided via a real-time audio and video communication system can be billed for members at home or another location. We recommend providers bill POS 02 beginning July 1, 2022 for virtual services (instead of a face-to-face POS). Treatment is supportive only and focused on symptom relief. Cigna waived cost-share for COVID-19 related treatment, in both inpatient and outpatient settings, through February 15, 2021 dates of service. 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. 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. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board. 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. lock As of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. 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. Cigna will 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, EEG or EKG testing). Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. . We are your billing staff here to help. Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; for services delivered via telehealth. * POS code 10 POS code name Learn about the medical, dental, pharmacy, behavioral, and voluntary benefits your employer may offer. (99441, 98966, 99442, 98967, 99334, 98968). Providers could deliver any face-to-face service on their fee schedule virtually, including those not related to COVID-19, for dates of service through December 31, 2020. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. When specific contracted rates are in place for diagnostic COVID-19 tests, Cigna will reimburse covered services at those contracted rates. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. All Time (0 Recipes) Past 24 Hours Past Week Past month. 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. A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. My daily insurance billing time now is less than five minutes for a full day of appointments. ) Unless telehealth requirements are . You'll always be able to get in touch. 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 providers whose contracts utilize a different reimbursement Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. Subscribe now with just HK$100. Modifier CR or condition code DR can also be billed instead of CS. Effective for dates of service on and after January 1, 2021, we implemented a new R31 Virtual Care Reimbursement Policy. However, Cigna will still consider requestes for accelerated credentialing on a case-by-case basis. Prior authorization is not required for COVID-19 testing. The Department may not cite, use, or rely on any guidance that is not posted 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). MLN Matters article MM7631, Revised and clarified place of service (POS) coding instructions. 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. Listing Results Cigna Telehealth Place Of Service. Precertification (i.e., prior authorization) requirements remain in place. Our newest Playbook in the series focuses on the implementation of telehealth (PDF), defined as real-time, audio-visual visits between a clinician and patient. Yes. 2. 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/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. 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 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. identify telehealth or telephone (audio only) services that were historically performed in the office or other in person setting (E.g. Every provider we work with is assigned an admin as a point of contact. Store and forward communications (e.g., email or fax communications) are not reimbursable. The 02 Place of Service code will automatically populate onto your courtesy claims and Superbills when the appointment is scheduled at that 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. Emotional health resources have been added to the COVID-19 interim guidance page for behavioral providers at CignaforHCP.com. Listed below are place of service codes and descriptions. Please note that we continue to closely monitor and audit claims for inappropriate services that could not be performed virtually (e.g., acupuncture, all surgical codes, anesthesia, radiology services, laboratory testing, administration of drugs and biologics, infusions or vaccines, EEG or EKG testing, etc.). Additionally, when you bill POS 02, your patients may also pay a lower cost-share for the virtual services they receive due to a recent change in some plan benefits. If you are rendering services as part of a facility (i.e., intensive outpatient program . If specimen collection and a laboratory test are billed together, only the laboratory test will be reimbursed. It's convenient, not costly. Yes. Providers should bill one of the above codes, along with: No. This is an extenuating circumstance. Once completed, telehealth will be added to your Cigna specialty. The provider will need to code appropriately to indicate COVID-19 related services. M0222 (administration in facility setting): $350.50, M0223 (administration in home setting): $550.50. This includes providers who typically deliver services in a facility setting. Customers will be referred to seek in-person care. 4. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. MLN Matters article MM12549, CY2022 telehealth update Medicare physician fee schedule. This will allow for quick telephonic consultations related to COVID-19 screening or other necessary consults, and will offer appropriate reimbursement to providers for this amount of time. Cigna commercial and Cigna Medicare Advantage will waive the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. 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. 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. Yes. When specific contracted rates are in place for COVID-19 specimen collection services, Cigna will reimburse covered services at those contracted rates. This guidance applies to all providers, including laboratories. POS 02: Telehealth Provided Other than in Patient's Home The location where health services and health related services are provided or received, through telecommunication technology. They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. Cigna recommends video services but allows telephonic sessions; however they may require review for medical necessity.