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Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. 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. Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. 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 Free Account Setup - we input your data at signup. No. This is an extenuating circumstance. 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). Patient is not located in their home when receiving health services or health related services through telecommunication technology. 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. As of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. Cigna will determine coverage for each test based on the specific code(s) the provider bills. For other laboratory tests when COVID-19 may be suspected. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. 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. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. 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. This guidance applies to all providers, including laboratories. 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. We are awaiting further billing instructions for providers, as applicable, from CMS. INTERIM TELEHEALTH GUIDANCE Announcement from Cigna Behavioral Health . 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. When specific contracted rates are in place for COVID-19 vaccine administration services, Cigna will reimburse covered services at those contracted rates. 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. All Time (0 Recipes) Past 24 Hours Past Week Past month. For details, see the CMS document titled Place of Service Codes for Professional Claims Database (updated September 2021). Urgent care centers can also bill their typical S9083 code for services that are more complex than a quick telephone call. Yes. 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. These codes are used to report episodes of patient care initiated by an established patient or guardian of an established patient. Virtual care offered by Urgent Care Centers billing with code S9083 is reimbursable until further notice. 1 In an emergency, always dial 911 or visit the nearest hospital. 24/7, live and on-demand for a variety of minor health care questions and concerns. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. In all cases, reimbursement will only be provided for hospital outpatient services performed in a clinic setting (including drive-thru testing sites) when billed on a UB-04 claim form with an appropriate revenue code. 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 . Yes. Providers should append the GQ, GT, or 95 modifier and Cigna will reimburse them consistent with their face-to-face rates. ), 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. This is a key difference between Commercial and Medicare risk . He co-founded a mental health insurance billing service for therapists called TheraThink in 2014 to specifically solve their insurance billing problems. As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. If specimen collection and a laboratory test are billed together, only the laboratory test will be reimbursed. 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. Previously, these codes were reimbursable as part of our interim COVID-19 accommodations. As private practitioners, our clinical work alone is full-time. 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. Please visit. The codes may only be billed once in a seven day time period. means youve safely connected to the .gov website. 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. 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.). 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. (Effective January 1, 2003), A facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to tribal members who do not require hospitalization. In 2017, Cigna launched behavioral telehealth sessions for all their members. 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. When multiple services are billed along with S9083, only S9083 will be reimbursed. The .gov means its official. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Cost-share will be waived for COVID-19 related services only when providers bill the appropriate ICD-10 code and modifier CS. Consistent with federal guidelines for private insurers, Cigna commercial will cover up to eight over-the-counter (OTC) diagnostic COVID-19 tests per month (per enrolled individual) with no out-of-pocket costs for claims submitted by a customer under their medical benefit. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. New/Modifications to the Place of Service (POS) Codes for Telehealth. Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication). As always, we remain committed to ensuring that: Yes. While we will not reimburse the drug itself when a provider receives it free of charge, we request that providers continue to bill the drug on the claim using the CMS code for the specific drug, along with a nominal charge (e.g., $.01), to assist with tracking purposes. Yes. 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, Most synchronous technology to be used (e.g., FaceTime, Skype, Zoom, etc. 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. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. lock Specimen collection is not generally paid in addition to other services on the same date of service for the same patient whether billed on the same or different claims by the same provider. Yes. No additional credentialing or notification to Cigna is required. More information about coronavirus waivers and flexibilities is available on . Instead, we request that providers bill POS 02 for all virtual care in support of the new client benefit plan option that lowers cost-share for certain customers who receive virtual care. Hospitals are still required to make their best efforts to notify Cigna of hospital admissions in part to assist with discharge planning. Please review these changes by going to the Provider FastFax page and selecting fax number 30. Providers should bill this code for dates of service on or after December 23, 2021. We are committed to helping providers deliver care how, when, and where it best meets the needs of their patients. No. Please review the Virtual care services frequently asked questions section on this page for more information. Yes. A federal government website managed by the 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. You get connected quickly. This generally takes place in a mass immunization setting, such as, a public health center, pharmacy, or mall but may include a physician office setting. For services where COVID-19 is not the initial clinical presentation (e.g., appendectomy, labor and delivery, etc. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. Precertification (i.e., prior authorization) requirements remain in place. Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. All synchronous technology used must be secure and meet or exceed federal and state privacy requirements. eConsult services remain covered; however, customer cost-share applies as of January 1, 2022. 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. 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. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically 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. Unless telehealth requirements are . Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. Cigna will allow direct emergent or urgent transfers from an acute inpatient facility to a second acute inpatient facility, skilled nursing facility (SNF), acute rehabilitation facility (AR), or long-term acute care hospital (LTACH). 4. No. Issued by: Centers for Medicare & Medicaid Services (CMS). Must be performed by a licensed provider. Cigna will only reimburse claims for covered OTC COVID-19 tests submitted by customers under their medical benefit and by certain pharmacy retailers under the pharmacy benefit, as elected by clients. When the condition being billed is a post-COVID condition, please submit using ICD-10 code U09.9 and code first the specific condition related to COVID-19. Heres how you know. A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02. When no specific contracted rates are in place, Cigna will reimburse all covered COVID-19 diagnostic tests consistent with CMS reimbursement to ensure consistent, timely, and reasonable reimbursement. 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). Non-residential Substance Abuse Treatment Facility, Non-residential Opioid Treatment Facility, A location that provides treatment for opioid use disorder on an ambulatory basis. Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. Area (s) of Interest: Payor Issues and Reimbursement. We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information. No. Total 0 Results. 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. This policy will be reviewed periodically for changes based on the evolving COVID-19 PHE and updated CMS or state specific rules 1 based on executive orders. Once completed, telehealth will be added to your Cigna specialty. 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. As of January 1, 2022, a new POS code has been approved to report more specifically where services were provided. You can decide how often to receive updates. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. 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. 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. You free me to focus on the work I love!. For example, talking to a board-certified doctor for a minor medical issue costs less than an ER or urgent care center, and may even be less than an in-office Primary Care Provider (PCP) visit. Please note, however, that we consider a providers failure to request an authorization due to COVID-19 an extenuating circumstance in the same way we view care provided during or immediately following a natural catastrophe (e.g., hurricane, tornado, fires, etc.). All health insurance policies and health benefit plans contain exclusions and limitations. "Medicare hasn't identified a need for new POS code 10. Urgent Care vs. the Emergency Room7 Ways to Help Pay Less for Out-of-Pocket Costs, What is Preventive Care?View all articles. Yes. How Can You Tell Which Specific Technology is Reimbursable? 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. Coverage reviews for appropriate levels of care and medical necessity will still apply. 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. 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 This includes providers who typically deliver services in a facility setting. I cannot capture in words the value to me of TheraThink. 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). Obtain your Member Code with just HK$100. M misstigris Networker Messages 63 Location Portland, OR The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. Yes. Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours. 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. For the immediate future, we will continue to reimburse virtual care services consistent with face-to-face rates. Product availability may vary by location and plan type and is subject to change. Under My Account > Settings > Practice Details, you can select the Insurance Place of Service code associated with sessions held via video. 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. 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). 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. Our mental health insurance billing staff is on call Monday Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy. 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. 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. 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). (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). Important notes: For additional information about Cigna's coverage of medically necessary diagnostic COVID-19 tests, please review the COVID-19 In Vitro Diagnostic Testing coverage policy. COVID-19 OTC tests used for employment, travel, participation in sports or other activities are not covered under this mandate. bill a typical face-to-face place of service (e.g., POS 11) . It's convenient, not costly. Your access portal for updated claims and reports is secured via our HTTPS/SSL/TLS secured server. Cigna covers diagnostic antibody tests when the results of the antibody test will be used to aid in the diagnosis of a condition related to COVID-19 antibodies (e.g., Multisystem Inflammatory Syndrome). 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. No. 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. Place of Service Code Set. Approximately 98% of reviews are completed within two business days of submission. 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). Cigna commercial and Cigna Medicare Advantage customers receive the COVID-19 vaccine with no out-of-pocket costs; and. No. As the government is providing the initial vaccine doses free of charge to health care providers, Cigna will not reimburse providers for the cost of the vaccine itself. 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. A freestanding facility, other than a physician's office, where surgical and diagnostic services are provided on an ambulatory basis. new codes. 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. 5 Virtual dermatological visits through MDLIVE are completed via asynchronous messaging. 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. Neither U0003 nor U0004 should be used for tests that are used to detect COVID-19 antibodies. Prior authorization is not required for COVID-19 testing. Yes. 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. No. eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. 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. Reimbursement for codes that are typically billed include: Yes. Until further notice, we will continue to made additional virtual care accommodations by allowing: eConsults are when a treating health care provider seeks guidance from a specialist physician through electronic means (e.g., phone, Internet, EHR consultation) to help manage care that is beyond the treating health care provider's usual practice.Typical examples include: Yes. Cigna will factor in the current strain on health care systems and will incorporate this information into retrospective reviews. Talk to a licensed dentist via a video call, 24/7/365. A facility maintained by either State or local health departments that provides ambulatory primary medical care under the general direction of a physician. On-demand virtual care for minor medical conditions, Talk therapy and psychiatry from the privacyof home. No. Before sharing sensitive information, make sure youre on a federal government site. For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. 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. 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. Providers should bill one of the above codes, along with: No. 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. Cigna will also administer the waiver for self-insured group health plans and the company encourages widespread participation, although these plans will have an opportunity to opt-out of the waiver option or opt-in to extend the waiver past February 15, 2021. Cigna has not lifted precertification requirements for scheduled surgeries. Cigna may not control the content or links of non-Cigna websites. Antibody tests: 86328, 86769, 86408, 86409, 86413, and 0224U, Cigna covers diagnostic molecular and antigen tests for COVID-19 through at least. Cigna covers the administration of the COVID-19 vaccine with no customer cost-share (i.e., no deductible or co-pay) when delivered by any provider or pharmacy. For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. Diluents are not separately reimbursable in addition to the administration code for the infusion. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. ** The Benefits of Virtual Care No waiting rooms. In addition, the discharging provider or primary care physician can provide the post discharge visit virtually if appropriate. 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.