It remains expected that the service billed is reasonable to be provided in a virtual setting. Diluents are not separately reimbursable in addition to the administration code for the infusion. 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. Through this feedback and research, we developed a list of covered services that we believe are most appropriate to be offered virtually across multiple specialties. 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. Let us handle handle your insurance billing so you can focus on your practice. 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. 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. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. Yes. Store and forward communications (e.g., email or fax communications) are not reimbursable. Please note that while virtual care services billed on a UB-04 claim will not typically be reimbursed under this policy, we continue to reimburse virtual care services billed on a UB-04 claim form until further notice as a COVID-19 accommodation when the services: Please note that existing reimbursement policies will apply and may affect claims payment (e.g., R30 E&M Services). Billing guidelines: Optum Behavioral Health will reimburse telehealth services which use standard CPT codes and a GT modifier or a Place of Service of 02 for We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. We will continue to assess the situation and adjust to market needs as necessary. No. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. incorporated into a contract. That is why in 2015, CMS began reimbursing providers for a program called non-complex Chronic Care Management (CCM), billed as the new code CPT 99490. We maintain all current medical necessity review criteria for virtual care at this time. Please note that we continue to request that providers do not bill with modifiers 93 or FQ at this time. State and federal mandates, as well as customer benefit plan designs, may supersede our guidelines. One of our key goals is to help customers connect to affordable, predictable, and convenient care anytime, anywhere. Cigna may request the appropriate CLIA-certification or waiver as well as the manufacturer and name of the test being performed. Yes, the cost-share waiver for COVID-19 treatment ended on February 15, 2021. A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. 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. 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. 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. Maybe. As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. 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. Yes. If a provider was reimbursed for a face-to-face service per their existing fee schedule, then they were reimbursed the same amount even if they delivered the service virtually. A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. Download and . A federal government website managed by the Please note that HMO and other network referrals remained required through the pandemic, so providers should have continued to follow the normal process that has been in place. Obtain your Member Code with just HK$100. Free Account Setup - we input your data at signup. Before sharing sensitive information, make sure youre on a federal government site. You get connected quickly. If a provider typically delivered face-to-face services in a facility setting, that provider could also deliver any appropriate service virtually consistent with existing Cigna policies through December 31, 2020 dates of service. Official websites use .govA 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. Telehealth services not billed with 02 will be denied by the payer. Refer to the Telemedicine Website for a list of billing codes which may be used with Place of Service (POS) 02 or 10. For other laboratory tests when COVID-19 may be suspected. (Description change effective January 1, 2016). Excluded physician services may be billed Unlisted, unspecified and nonspecific codes should be avoided. The Administration's plan is to end the COVID-19 public health emergency (PHE) on May 11, 2023. Therefore, FaceTime, Skype, Zoom, etc. 1 For services included in our Virtual Care Reimbursement Policy, a number of general requirements must be met for Cigna to consider reimbursement for a virtual care visit. A location, not part of a hospital and not described by any other Place of Service code, that is organized and operated to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to outpatients only. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. ) PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. a listing of the legal entities Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. 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. There may be limited exclusions based on the diagnoses submitted. M0222 (administration in facility setting): $350.50, M0223 (administration in home setting): $550.50. No additional modifiers are necessary to include on the claim. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board. Yes. Throughout the pandemic, the emergency use authorized monoclonal antibody drug bebtelovimab was purchased by the federal government and offered to providers for free. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. 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). 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 For covered virtual care services cost-share will apply as follows: No. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. 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. Comprehensive Outpatient Rehabilitation Facility. 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. A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.). When billing, you must use the most appropriate code as of the effective date of the submission. 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. 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. 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. 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. Therefore, as of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. Separate codes providers may use to bill for supplies are generally considered incidental to the overall primary service and are not reimbursed separately. 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 . Comprehensive Inpatient Rehabilitation Facility. 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. Contracted providers cannot balance bill customers for non-reimbursable codes. You can decide how often to receive updates. In addition, the discharging provider or primary care physician can provide the post discharge visit virtually if appropriate. CPT 99490 covers at least 20 minutes of non-face-to-face chronic care management services provided by clinical staff. For virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02. Last updated February 15, 2023 - Highlighted text indicates updates. 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). This guidance applies to all providers, including laboratories. No. Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. When no specific contracted rates are in place, Cigna will reimburse the administration of all emergency use authorized (EUA) vaccines at the established national, Cigna will reimburse vaccinations administered in a home setting an additional $35.50 per dose consistent with the established national. No. 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. ICD-10 code U07.1, J12.82, M35.81, or M35.89. Previously, these codes were reimbursable as part of our interim COVID-19 accommodations. 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. A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided. Providers will continue to be reimbursed at 100% of their face-to-face rates for covered virtual care services, even when billing POS 02. Cigna currently allows for the standard timely filing period plus an additional 365 days. We recommend providers bill POS 02 beginning July 1, 2022 for virtual services (instead of a face-to-face POS). Yes. Approximately 98% of reviews are completed within two business days of submission. Yes. Providers should bill the pre-admission or pre-surgical testing of COVID-19 separately from the surgery itself using ICD-10 code Z01.812 in the primary position. .gov As always, we remain committed to providing further updates as soon as they become available. Note: This article was updated on January 26, 2022, for clarification purposes. MLN Matters article MM12427, New modifications to place of service (POS) codes for telehealth. Psychiatric Facility-Partial Hospitalization. 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. Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. In 2017, Cigna launched behavioral telehealth sessions for all their members. When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9. You can call, text, or email us about any claim, anytime, and hear back that day. Diluents are not separately reimbursable in addition to the administration code for the infusion. Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. 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. For example, if a patient presents at an emergency room with a suspected broken ankle after a fall and is also tested for COVID-19 during the visit, Cigna would cover services related to treating the ankle at standard customer cost-share, while the COVID-19 laboratory test would be covered at no customer cost-share. 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. Cigna will reimburse at 100% of face-to-face rates, even when billing POS 02. At this time, providers who offer virtual care will not be specially designated within our public provider directories. 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 home facility (place of service 32), or to an individuals home (place of service 12) to collect the specimen. 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). 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. 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). Standard cost-share will apply for the customer, unless waived by state-specific requirements. (Effective January 1, 2016). Congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services. 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. Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. (As of 01/21/2021) What Common Procedural Technology (CPT) codes should be used for COVID-19 testing? Cigna waived cost-share for COVID-19 related treatment, in both inpatient and outpatient settings, through February 15, 2021 dates of service. You get connected quickly. The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. "Medicare hasn't identified a need for new POS code 10. Because we believe virtual care has the potential to help you attract and retain patients, reduce access barriers, and contribute to your ability to provide the right care at the right time, we wanted to implement a policy that ensures you can continue to receive ongoing reimbursement for virtual care that you deliver to your patients with Cigna commercial medical coverage. 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. 4. Most mental health providers will be furnishing services using Place of Service code 10 (POS 10) when providing telehealth services. Coverage reviews for appropriate levels of care and medical necessity will still apply. ), Preventive care codes (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) (Effective with January 29, 2022 dates of service), A quick 5- to 10-minute telephone conversation between a provider and their patient (G2012), eConsults (99446-99449, 99451, and 99452), Virtual home health services (G0151, G0152, G0153, G0155, G0157, G0158, G0299, G0300, G0493, S9123, S9128, S9129, and S9131). 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. Virtual care offered by Urgent Care Centers billing with code S9083 is reimbursable until further notice. 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. What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? website belongs to an official government organization in the United States. Providers that administer vaccinations to patients without health insurance or whose insurance does not provide coverage of vaccination administration fees, may be able to file a claim with the provider relief fund, but may not charge patients directly for any vaccine administration costs. The codes may only be billed once in a seven day time period. All other customers will have the same cost-share as if they received the services in-person from that same provider. 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. 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. Summary of Codes for Use During State of Emergency. There are two primary types of tests for COVID-19: A serology (i.e., antibody) test for COVID-19 is considered diagnostic and covered without cost-share through at least May 11, 2023 when ALL of the following criteria are met: When specific contracted rates are in place for diagnostic COVID-19 serology tests, Cigna will reimburse covered services at those contracted rates. To this end, we appreciate the feedback and deep collaboration weve had with provider groups and medical societies regarding virtual care. A facility, other than a patient's home, in which palliative and supportive care for terminally ill patients and their families are provided. Cigna Telehealth Place of Service Code: 02. 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. If specimen collection and a laboratory test are billed together, only the laboratory test will be reimbursed. Cigna covers C9803 with no customer cost-share for a hospital outpatient clinic visit specimen collection, including drive-thru tests, through at least May 11, 2023 only when billed without any other codes. CMS now defines these two telemedicine place of service (POS) codes: POS 02: Telehealth Provided Other than in Patient's Home Descriptor: The location where health services and health related services are provided or received, through telecommunication technology. You free me to focus on the work I love!. 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. 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. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. A facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on a 24-hour basis, by or under the supervision of a physician. Transport between facilities such as hospitals and SNFs and hospitals and Acute Rehab centers is also covered without prior authorization. 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. Cigna will not reimburse providers for the cost of the vaccine itself. 24/7, live and on-demand for a variety of minor health care questions and concerns. Under My Account > Settings > Practice Details, you can select the Insurance Place of Service code associated with sessions held via video. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. 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. Denny has interviewed hundreds of mental health practitioners to better understand their struggles and solutions, all with the goal of making the professional side of behavioral health a little easier, faster, and less expensive. No virtual care modifier is needed given that the code defines the service as an eConsult. You can call, text, or email us about any claim, anytime, and hear back that day. Please review our R33 COVID-19 Interim Billing Guidelines policy for ICD-10 diagnosis code requirements to have cost-share waived for G2012. Yes. While as part of this policy, Urgent Care centers billing virtual care on a global S code is not reimbursable, we do continue to reimburse these services until further notice as part of our interim COVID-19 guidelines. If a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. 3. Cigna will factor in the current strain on health care systems and will incorporate this information into retrospective reviews. 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. Hi Laelia, I'd be happy to help. All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02. Yes. A medical facility operated by one or more of the Uniformed Services. 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. For more information, see the resources along the right-hand side of the screen. 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. ), but the patient is also tested for COVID-19 for diagnostic reasons, the provider should bill the diagnosis code specific to the primary reason for the encounter in the first position, and the COVID-19 diagnosis code in any position after the first. For additional information about our coverage of the COVID-19 vaccine, please review our. No. Cigna will only cover non-diagnostic PCR, antigen, and serology (i.e., antibody) tests when covered by the client benefit plan. 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. 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. 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. A walk-in health clinic, other than an office, urgent care facility, pharmacy or independent clinic and not described by any other Place of Service code, that is located within a retail operation and provides, on an ambulatory basis, preventive and primary care services. Share sensitive information only on official, secure websites. 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 . 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. UnitedHealthcare (UHC) is now requiring physicians to bill eligible telehealth services with place of service (POS) 02 for commercial products. In addition, Anthem would recognize telephonic-only . lock 4 Due to state laws governing teledentistry, this service is not available to residents of Texas. Patient is not located in their home when receiving health services or health related services through telecommunication technology. Similarly, if a cardiologist is brought in to consult in a face-to-face setting within a facility setting, that cardiologist can also provide services virtually billing a face-to-face evaluation and management (E&M) visit (the same code[s] on their fee schedule and the same claim form [e.g., CMS 1500 or UB-04]). Providers receive reasonable reimbursement consistent with national CMS rates for administering EUA-approved COVID-19 vaccines. No. End-Stage Renal Disease Treatment Facility. We are your billing staff here to help. This guidance applies to all providers, including laboratories. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. The location where health services and health related services are provided or received, through telecommunication technology. Cigna remains adequately staffed to respond to all new precertification requests for elective procedures within our typical timelines. PT/OT/ST providers could deliver virtual care for any service that was on their fee schedule for dates of service through December 31, 2020.
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