(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. 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. U.S. Department of Health & Human Services The .gov means its official. 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. Yes. 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. 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. Please note that cost-share still applies for all non-COVID-19 related services. We are committed to helping providers deliver care how, when, and where it best meets the needs of their patients. Place of Service 02 in Field 24-B (see sample claim form below) For illustrative purposes only. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. 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 the individual test is not part of a panel, but is part of a series of other pathogen tests that are performed, unbundling edits may apply. For dates of service April 1 - June 30, 2022, Cigna will apply a 1% payment adjustment. Yes. Additional FDA EUA approved vaccines will be covered consistent with this guidance. Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis. 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. Providers should bill the relevant vaccine administration code (e.g., 0001A, 0002A, etc.) 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. 2. website belongs to an official government organization in the United States. Urgent Care vs. the Emergency Room7 Ways to Help Pay Less for Out-of-Pocket Costs, What is Preventive Care?View all articles. 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. Also consistent with CMS, we will reimburse providers an additional $25 when they return the result of the test to the patient within two days and bill Cigna code U0005. representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). Cigna follows CMS rules related to the use of modifiers. Location, other than a hospital or other facility, where the patient receives care in a private residence. 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 implemented a Virtual Care Reimbursement Policy for commercial medical services, effective January 1, 2021.1 This policy ensures you can continue to receive ongoing reimbursement for virtual care provided to your patients with Cigna commercial medical coverage.2. Cigna does not generally cover tests for asymptomatic individuals when the tests are performed for general public health surveillance, for employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19. *Please Note: virtual check-in and E-visit codes must be billed with Place of Service (POS) 02 and modifier GT. Providers can bill code G2012 for a quick 5-10 minute phone conversation as part of our R31 Virtual Care Reimbursement Policy, with cost-share waived through at least May 11, 2023 for customers when the conversation is related to COVID-19. 1995-2020 by the American Academy of Orthopaedic Surgeons. A location which provides treatment for substance (alcohol and drug) abuse on an ambulatory basis. Services include physical therapy, occupational therapy, and speech pathology services. **, Watch this short video to learn more about virtual care with MDLivefor Cigna.(Length: 00:01:33). You get connected quickly. First Page. 3 Biometric screening experience may vary by lab. The facility that the patient is being transferred to (e.g., SNF, AR, or LTACH) is responsible for notifying Cigna of admissions the next business day. While we encourage providers to bill virtual care consistent with an office visit and understand that certain services can be time consuming and complex even when provided virtually we strongly encourage providers to be cognizant when billing level four and five codes for virtual services. Effective January 1, 2021, we implemented a new. Cigna understands the tremendous pressure our healthcare delivery systems are under. As long as one of these modifiers is included for the appropriate procedure code(s), the service will be considered to have been performed virtually. 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. And as customers 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. M misstigris Networker Messages 63 Location Portland, OR Yes. or Precertification (i.e., prior authorization) requirements remain in place. The codes may only be billed once in a seven day time period. Cigna currently allows for the standard timely filing period plus an additional 365 days. More information about coronavirus waivers and flexibilities is available on . For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. DISCLAIMER: The contents of this database lack the force and effect of law, except as Please note that some opt-outs for self-funded benefit plans may have applied. Yes. Cigna does require prior authorization for fixed wing air ambulance transport. Patient is not located in their home when receiving health services or health related services through telecommunication technology. 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. 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. 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 . 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. 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]). Modifier 95, indicating that you provided the service via telehealth. All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02. Telehealth services not billed with 02 will be denied by the payer. No. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). No. Please visit CignaforHCP.com/virtualcare for additional information about that policy. Yes. 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. Cost share is waived for all covered eConsults through December 31, 2021. 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. We also referenced the current list of covered virtual care codes by the CMS to help inform our coverage strategy. 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. In addition, Cigna recognizes and expects that providers will continue to follow their usual business practices regarding onboarding new providers, locum tenens, and other providers brought in to cover practices or increase care during times of high demand. Here is a complete list of place of service codes: Place of Service Codes. 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. 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. A federal government website managed by the Billing Guidelines: Optum will reimburse telehealth services which use standard CPT codes for outpatient treatment and a GT, GQ or 95 modifier for either a video-enabled virtual visit or a telephonic session, to indicate the visit was conducted remotely. Yes. 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. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. Thanks for your help! Billing for telehealth nutrition services may vary based on the insurance provider. Providers receive reasonable reimbursement consistent with national CMS rates for administering EUA-approved COVID-19 vaccines. Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication). Yes. Yes. Unless telehealth requirements are . Before sharing sensitive information, make sure youre on a federal government site. While Cigna doesn't require further credentialing or license validation, and the provider can work under the scope of their license, providers are encouraged to inform Cigna when they will practice across state lines. 3. No. As always, we remain committed to ensuring that: Yes. Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. A serology test is a blood test that measures antibodies. lock Sign up to get the latest information about your choice of CMS topics. Yes. 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. Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. Additionally, certain virtual care services and accommodations that are not generally reimbursable under the Virtual Care Reimbursement Policy remain reimbursable as part of our continued interim COVID-19 virtual care guidelines until further notice. 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. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. 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. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. Transport between facilities such as hospitals and SNFs and hospitals and Acute Rehab centers is also covered without prior authorization. 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. What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? Customers will be referred to seek in-person care. Providers can call Cigna customer service at 1.800.88Cigna (882.4462) to check a patients eligibility information, including if their plan offers coverage for these purposes. 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. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). When billing for the service, indicate the place of service as where the visit would have occurred if in person. These codes should be used on professional claims to specify the entity where service (s) were rendered. Yes. Yes. Area (s) of Interest: Payor Issues and Reimbursement. 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. 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. 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. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. No additional modifiers are necessary. When providers purchase the drug itself from the manufacturer (e.g., bebtelovimab billed with Q0222), Cigna will reimburse the cost of the drug when covered. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. The interim COVID-19 virtual care guidelines were solely in place through December 31, 2020, and this new policy took effect on January 1, 2022. Listed below are place of service codes and descriptions. Listing Results Cigna Telehealth Place Of Service. 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 reimburse providers the full allowed amount of the claim, including what would have been the customer's cost share. A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients. Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. Last updated February 15, 2023 - Highlighted text indicates updates. The ordering provider should use the standard, existing process to submit home health orders to eviCore healthcare. Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004. 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. Federal government websites often end in .gov or .mil. Is Face Time allowed? 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 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. Reimbursement, when no specific contracted rates are in place, are as follows: No. 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. A facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services by, or under, the supervision of physicians to patients admitted for a variety of medical conditions. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. One of our key goals is to help your patients connect to affordable, predictable, and convenient care anytime, anywhere. No. 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. 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. At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. Cigna will reimburse at 100% of face-to-face rates, even when billing POS 02. Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. All health insurance policies and health benefit plans contain exclusions and limitations. 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. However, facilities will not be penalized financially for failure to notify us of admissions. Modifier CR or condition code DR can also be billed instead of CS. Cigna commercial and Cigna Medicare Advantage are waiving the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. 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. 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 residence, with shared living areas, where clients receive supervision and other services such as social and/or behavioral services, custodial service, and minimal services (e.g., medication administration). Customer cost-share will be waived for COVID-19 related virtual care services through at least. The following Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes are used to bill for telebehavioral and telemental health services and have been codified into the current Medicare Physician Fee Schedule (PFS). 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. Providers should append the GQ, GT, or 95 modifier and Cigna will reimburse them consistent with their face-to-face rates. The location where health services and health related services are provided or received, through telecommunication technology. Yes. For more information about current Evernorth Behavioral Health virtual care guidance, please visit CignaforHCP.com > Resources > Behavioral Resources > Doing Business with Cigna > COVID-19: Interim Guidance. Share sensitive information only on official, secure websites. 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. When no contracted rates are in place, Cigna will reimburse covered diagnostic serology laboratory tests consistent with CMS reimbursement, including $42.13 for code 86769 and $45.23 for code 86328, to ensure consistent, timely, and reasonable reimbursement. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. Non-residential Substance Abuse Treatment Facility, Non-residential Opioid Treatment Facility, A location that provides treatment for opioid use disorder on an ambulatory basis. You'll always be able to get in touch. (Effective January 1, 2003). Yes. This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. 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. Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. When no specific contracted rates are in place, Cigna will reimburse covered services at the established national CMS rates to ensure timely, consistent, and reasonable reimbursement. Mid-level practitioners (e.g., physician assistants and nurse practitioners) can also provide services virtually using the same guidance. Cost-share will be waived for COVID-19 related services only when providers bill the appropriate ICD-10 code and modifier CS. Please review the Virtual care services frequently asked questions section on this page for more information. "All Rights Reserved." This website and its contents may not be reproduced in whole or in part without . Yes. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. We also continue to work directly with providers to understand the financial implications that virtual care reimbursement may have on practices. 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. For telephone services only, codes are time based. 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. No. 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. While the policy - announced in United's . The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. Cigna will not make any requirements as it relates to virtual services being for a new or existing patient. Prior to the COVID-19 PHE, the patient's place of service was indicated with code 02, which previously indicated all telehealth patient sites. A facility, other than a patient's home, in which palliative and supportive care for terminally ill patients and their families are provided. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Secure .gov websites use HTTPSA If an urgent care center administers a quick uniform screening (questionnaire) that does not result in a full evaluation and management service of any level and then performs a COVID-19 test OR a collection service, they should bill only the laboratory code OR collection code. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. You can call, text, or email us about any claim, anytime, and hear back that day. 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. Free Account Setup - we input your data at signup. Concurrent review will start the next business day with no retrospective denials. 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. At this time, providers who offer virtual care will not be specially designated within our public provider directories. Reimbursement for the administration of the injection will remain the same. 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 will waive the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. Yes. 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 more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. Cigna will allow commercial and behavioral providers who are participating with Cigna (and who have up-to-date credentialing) to provide in-person or virtual care in other states to the extent that the scope of the license and state regulations allow such care to take place. Primary care physician referrals for specialist office visits were temporarily waived for Individual & Family Plans (IFP) in Illinois and for all SureFit plans through May 31, 2021. Under normal circumstances, the provider would bill with the Place of Service code 2, to indicate the care was rendered via telehealth. Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; Primary care physician to specialist requesting input from a cardiologist, psychiatrist, pulmonologist, allergist, dermatologist, surgeon, oncologist, etc. Telehealth claims with any other POS will not be considered eligible for reimbursement. After the emergency use authorization (EUA) or licensure of each COVID-19 vaccine product by the FDA, CMS will identify the specific vaccine code(s) along with the specific administration code(s) for each vaccine that should be billed.