A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders. 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. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. Please review our R33 COVID-19 Interim Billing Guidelines policy for ICD-10 diagnosis code requirements to have cost-share waived for G2012. A facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters). Your access portal for updated claims and reports is secured via our HTTPS/SSL/TLS secured server. POS 11, 19 and 22) modifier GT or 95 (or GQ for Medicaid) must be used. The location where health services and health related services are provided or received, through telecommunication technology. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. 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). (99441, 98966, 99442, 98967, 99334, 98968). 3 Biometric screening experience may vary by lab. We covered codes 99441-99443 as part of these interim COVID-19 guidelines, and continue to cover them as part of the R31 Virtual Care Reimbursement Policy. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. 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. Yes. You can call, text, or email us about any claim, anytime, and hear back that day. On July 2, 2021 MVP announced changes to member cost-share effective August 1, 2021. A serology test is a blood test that measures antibodies. No authorization is required for the procurement or administration of COVID-19 infusion treatments. Yes. Therefore, as of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. Yes. Please note that Cigna temporarily increased the precertification approval window for all elective inpatient and outpatient services - including advanced imaging - from three months to six months for dates of authorization beginning March 25, 2020 through March 31, 2021. You can decide how often to receive updates. Per usual protocol, emergency and inpatient imaging services do not require prior authorization. These codes do not need a place of service (POS) 02 or modifier 95 or GT. Yes. This guidance applies to all providers, including laboratories. In these cases, the urgent care center should append a GQ, GT, or 95 modifier, and we will reimburse the full face-to-face rate for insured and Non-ERISA ASO customers in states where telehealth parity laws exist. 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. .gov were all appropriate to use). All Cigna Customers will pay $0 ingredient cost while funded by government, while Cigna commercial customers will pay up to a $6 dispensing fee when obtained at a pharmacy where the medications are available. 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). TheraThink provides an affordable and incredibly easy solution. Yes. There may be limited exclusions based on the diagnoses submitted. We are committed to helping providers deliver care how, when, and where it best meets the needs of their patients. Providers should bill with POS 02 for all virtual care claims, as we updated our claims systems to ensure providers receive 100 percent of face-to-face reimbursement for covered virtual care when using POS 02. (As of 01/21/2021) What Common Procedural Technology (CPT) codes should be used for COVID-19 testing? As of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. or 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. Yes. 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. We understand that it's important to actually be able to speak to someone about your billing. 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. 1 When billing for telehealth, it's unclear what place of service code to use. Cigna will reimburse Remdesivir for COVID-19 treatment when administered in inpatient or outpatient settings at the national CMS reimbursement rate (or average wholesale pricing [AWP] if a CMS rate is not available) when the drug costs are not included in case rates or per diems to ensure timely, consistent, and reasonable reimbursement. 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. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. 1 In an emergency, always dial 911 or visit the nearest hospital. 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. 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. The POS Workgroup is revising the description of POS code 02 and creating a new POS code 10 to meet the overall industry needs, as follows: 1. Cigna allowed providers to bill a standard face-to-face visit for all virtual care services, including those not related to COVID-19, through December 31, 2020 dates of service. We are your billing staff here to help. Listed below are place of service codes and descriptions. Let us handle handle your insurance billing so you can focus on your practice. Yes. Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. Service performed: OEce or other outpatient visit for the evaluation and management of a new patient CPT code billed: 99202 Modier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): 100% of face-to-face rate Customer cost-share: Applies consistent with While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed 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. Medicare telehealth services practitioners use "02" if the telehealth service is delivered anywhere except for the patient's home. Cigna does require prior authorization for fixed wing air ambulance transport. 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. 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. Cigna Telehealth Place of Service Code: 02. In 2017, Cigna launched behavioral telehealth sessions for all their members. Free Account Setup - we input your data at signup. Certain virtual care services that were previously covered on an interim basis as part of our COVID-19 guidelines are now permanently covered as part of our Virtual Care Reimbursement Policy. All health insurance policies and health benefit plans contain exclusions and limitations. 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. The interim COVID-19 virtual care guidelines as outlined on this page were in place for dates of service through December 31, 2020. Cigna will generally not cover molecular, antigen, or antibody tests for asymptomatic individuals when the tests are performed for general population or public health surveillance, for employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19. 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. Cigna will reimburse providers the full allowed amount of the claim, including what would have been the customer's cost share. Place of Service 02 in Field 24-B (see sample claim form below) For illustrative purposes only. It depends upon the clients benefit plan, but as noted above, testing is usually not covered for these purposed because most standard Cigna client benefit plans do not cover non-diagnostic tests for these non-diagnostic reasons. No. At this time, providers who offer virtual care will not be specially designated within our public provider directories. 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. 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. Listed below are place of service codes and descriptions. As of June 1, 2021, these plans again require referrals. 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. bill a typical face-to-face place of service (e.g., POS 11) . Intermediate Care Facility/ Individuals with Intellectual Disabilities. Diluents are not separately reimbursable in addition to the administration code for the infusion. The ordering provider should use the standard, existing process to submit home health orders to eviCore healthcare. 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. Cigna currently allows for the standard timely filing period plus an additional 365 days. If you are rendering services as part of a facility (i.e., intensive outpatient program . For dates of service April 1 - June 30, 2022, Cigna will apply a 1% payment adjustment. 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). When no specific contracted rates are in place, we will reimburse this code at $22.99 consistent with CMS pricing to ensure consistent, timely, and reasonable reimbursement. Download and . Cost-share is waived only when billed by a provider or facility without any other codes. As always, we remain committed to providing further updates as soon as they become available. For costs and details of coverage, review your plan documents or contact a Cigna representative. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. When all requirements are met, covered services are currently reimbursed at 100% of face-to-face rates (i.e., parity). Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. More information about coronavirus waivers and flexibilities is available on . We added a number of additional codes in March and April 2022 that are now eiligible for reimbursement. 2 Limited to labs contracted with MDLIVE for virtual wellness screenings. Urgent care centers can also bill their typical S9083 code for services that are more complex than a quick telephone call. 4 Due to state laws governing teledentistry, this service is not available to residents of Texas. 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. 3. For telehealth, the 95 modifier code is used as well. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. Cigna commercial and Cigna Medicare Advantage customers receive the COVID-19 vaccine with no out-of-pocket costs; and. Yes. Yes. When billing, you must use the most appropriate code as of the effective date of the submission. When a state allows an emergent temporary provider licensure, Cigna will allow providers to practice in that state as participating if a provider is already participating with Cigna, is in "good standing," and if state regulations allow such care to take place. Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. HIPAA does not require patient consent for consultation and coordination of care with health care providers in the ordinary course of treatment for their patients. On January 1, 2021, we implemented a Virtual Care Reimbursement Policy that ensures permanent coverage of certain virtual care services. Heres how you know. Listing Results Cigna Telehealth Place Of Service. 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. Cost-share will be waived only when providers bill the appropriate ICD-10 code (U07.1, J12.82, M35.81, or M35.89). ( 24/7, live and on-demand for a variety of minor health care questions and concerns. 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. Diagnoses requiring testing cannot be confirmed. If antibodies are present, it means that individual previously had a specific viral or bacterial infection - like COVID-19. Customers will be referred to seek in-person care. Is there a code that we can use to bill for this other than 99441-99443? Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. No. Cigna will not reimburse providers for the cost of the vaccine itself. These include: Virtual preventive care, routine care, and specialist referrals. 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) When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. We will continue to monitor inpatient stays. For more information about current Evernorth Behavioral Health virtual care guidance, please visit CignaforHCP.com > Resources > Behavioral Resources > Doing Business with Cigna >, For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com >, Outpatient E&M codes for new and established patients (99202-99215), Physical and occupational therapy E&M codes (97161-97168), Annual wellness visit codes (G0438 and G0439), Services must be on the list of eligible codes contained within in our. lock These codes should be used on professional claims to specify the entity where service (s) were rendered. Coverage reviews for appropriate levels of care and medical necessity will still apply. "All Rights Reserved." This website and its contents may not be reproduced in whole or in part without . A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician. Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004. Similar to other vaccination administration (e.g., a flu shot), an E&M service and vaccine administration code should only be billed when a significant and separately identifiable E&M visit was performed at the same time as the administration of the vaccine. 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. No. 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. Modifier CR and condition code DR can also be billed instead of CS. When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. However, we believe that FDA and EUA-approved vaccines are safe and effective, and encourage our customers to get vaccinated. Per usual policy, Cigna does not require three days of inpatient care prior to transfer to a SNF. 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. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. Services include methadone and other forms of Medication Assisted Treatment (MAT). Ultimately however, care must be medically necessary to be covered. When specific contracted rates are in place for diagnostic COVID-19 tests, Cigna will reimburse covered services at those contracted rates. Antibody tests: 86328, 86769, 86408, 86409, 86413, and 0224U, Cigna covers diagnostic molecular and antigen tests for COVID-19 through at least. No. Yes. POS 02: Telehealth Provided Other than in Patient's Home New/Modifications to the Place of Service (POS) Codes for Telehealth. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. eConsult services remain covered; however, customer cost-share applies as of January 1, 2022. (As of 10/14/2020) Where can providers access the telemedicine policy and related codes? If the telephone, Internet, or electronic health record consultation leads to a transfer of care or other face-to-face service (e.g., a surgery, a hospital visit, or a scheduled office evaluation of the patient) within the next 14 days or next available appointment date of the consultant, these codes should not be billed. 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. Telehealth (also referred to as telemedicine) gives our members access to their health care provider from their home or another location. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. Mid-level practitioners (e.g., physician assistants and nurse practitioners) can also provide services virtually using the same guidance. Services may be rendered via telemedicine when the service is: A covered Health First Colorado benefit, Within the scope and training of an enrolled provider's license, and; Appropriate to be rendered via telemedicine. The COVID-19 billing and reimbursement guidelines that follow are for commercial Cigna medical services, including IFP, unless otherwise noted. No waiting rooms. What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? 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. Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; PT/OT/ST providers should continue to submit virtual claims with a GQ, GT, or 95 modifier and POS 02, and they will be reimbursed at their face-to-face rates. 200 Independence Avenue, S.W. While Cigna does not require any specific placement for COVID-19 diagnosis codes on a claim, we recommend providers include the COVID-19 diagnosis code for confirmed or suspected COVID-19 patients in the first position when the primary reason the patient is treated is to determine the presence of COVID-19. COVID-19 admissions would be emergent admissions and do not require prior authorizations. Yes. You get connected quickly. Specimen collection centers like these can also bill codes G2023 or G2024 following the preceding guidance. Insurance Reimbursement Rates for Psychotherapy, Insurance Reimbursement Rates for Psychiatrists, Beginners Guide To Mental Health Billing, https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf, guide on HIPAA compliant video technology for telehealth, https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf, Inquire about our mental health insurance billing service, offload your mental health insurance billing, We charge a percentage of the allowed amount per paid claim (only paid claims). I cannot capture in words the value to me of TheraThink. 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. CMS officially has designated a Place of Service code for all of the telehealth to be "02" starting April 1, 2020. These resources offer access to live-guided relaxation sessions, wellness podcasts, and wellness and stress management flyers. Transport between facilities such as hospitals and SNFs and hospitals and Acute Rehab centers is also covered without prior authorization. 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. 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. 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]). Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. 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. 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. Additionally, Cigna also continues to provide coverage for COVID-19 tests that are administered with a providers involvement or prescription after individualized assessment as outlined in this section and in Cignas COVID-19 In Vitro Diagnostic Testing coverage policy.