Separate codes providers may use to bill for supplies are generally considered incidental to the overall primary service and are not reimbursed separately. 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. Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. Cigna offers a number of virtual care options depending on your plan. Yes. 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. 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 Yes. On Aug. 3, 2020 CMS published a revision to the April 27th, 2020 memo announcing the addition of telephonic CPT codes (98966-98968, 99441-99443) valid for 2020 benefit year data submissions for the Department of Health and Human Services- (HHS-) operated risk adjustment program. Other Reimbursement Type. POS 02: Telehealth Provided Other than in Patient's Home Providers should bill the relevant vaccine administration code (e.g., 0001A, 0002A, etc.) Cost share is waived for all covered eConsults through December 31, 2021. Cigna will determine coverage for each test based on the specific code(s) the provider bills. This policy applied to customers in the United States who are covered under Cigna's employer/union sponsored insured group health plans, insured plans for US-based globally mobile individuals, Medicare Advantage, and Individual and Family Plans (IFP). As of July 1, 2022, we request that providers bill with POS 02 for all virtual care. No. Sign up to get the latest information about your choice of CMS topics. Deliver services that are covered by the Virtual Care Reimbursement Policy; Bill consistently with the requirements of the policy; and. Most mental health providers will be furnishing services using Place of Service code 10 (POS 10) when providing telehealth services. 3 Biometric screening experience may vary by lab. List the address of the physician for the telehealth visit on the CMS1500 claim. Yes. A medical facility operated by one or more of the Uniformed Services. Audio -only CPT codes 98966 98968 and 99441 POS codes are two-digit codes reported on . lock A freestanding facility, other than a physician's office, where surgical and diagnostic services are provided on an ambulatory basis. Last updated February 15, 2023 - Highlighted text indicates updates. 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. Telehealth claims with any other POS will not be considered eligible for reimbursement. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Let us handle handle your insurance billing so you can focus on your practice. Modifier CR or condition code DR can also be billed instead of CS. 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. 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. We are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. No. 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. Heres how you know. Additional FDA EUA approved vaccines will be covered consistent with this guidance. This guidance applies to all providers, including laboratories. Generally, only well-equipped commercial laboratories and hospital-based laboratories will have the necessary equipment to offer these tests. Telehealth (also referred to as telemedicine) gives our members access to their health care provider from their home or another location. (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. Summary of Codes for Use During State of Emergency. Please note that while Cigna Medicare Advantage plans do fully cover the costs for COVID-19 tests done in a clinical setting, costs of at-home COVID-19 tests are not a covered benefit. 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. Yes. representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). Cigna will not make any limitation as to the place of service where an eConsult can be used. It remains expected that the service billed is reasonable to be provided in a virtual setting. 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. Yes. CPT 99490 covers at least 20 minutes of non-face-to-face chronic care management services provided by clinical staff. 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. 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 maintain all current medical necessity review criteria for virtual care at this time. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. We also continue to work directly with providers to understand the financial implications that virtual care reimbursement may have on practices. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. Federal government websites often end in .gov or .mil. This will help with tracking purposes, and ensure timely reimbursement for the administration of the treatment. No. 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. 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. Please visit CignaforHCP.com/virtualcare for additional information about that policy. However, providers are required to attest that their designated specialty meets the requirements of Cigna. As private practitioners, our clinical work alone is full-time. Patient is not located in their home when receiving health services or health related services through telecommunication technology. Yes. Official websites use .govA 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. Contracted providers cannot balance bill customers for non-reimbursable codes. Yes. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. Recent guidelines have recommended keeping the normal service facility that you are registered under in your CMS-1500. New and revised codes are added to the CPBs as they are updated. As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. 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. Cigna has not lifted precertification requirements for scheduled surgeries. A serology test is a blood test that measures antibodies. We also continue to make several additional accommodations related to virtual care until further notice. Cigna commercial and Cigna Medicare Advantage will waive the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. This guidance applies to all providers, including laboratories. A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. Learn about the medical, dental, pharmacy, behavioral, and voluntary benefits your employer may offer. (As of 01/21/2021) What Common Procedural Technology (CPT) codes should be used for COVID-19 testing? Customer cost-share will be waived for COVID-19 related virtual care services through at least. This is true for Medicare or other insurance carriers. Therefore, please refer to those guidelines for services rendered prior to January 1, 2021. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. Please note that some opt-outs for self-funded benefit plans may have applied. 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. Services include methadone and other forms of Medication Assisted Treatment (MAT). Phone, video, FaceTime, Skype, Zoom, etc. Yes. If a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. For services provided through February 15, 2021, providers will need to bill consistent with our interim billing guidelines by including the Diagnosis code (Dx) U07.1, J12.82, M35.81, or M35.89 on claims related to the treatment of COVID-19. Listing Results Cigna Telehealth Place Of Service. 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. Live-guided relaxation by telephone Available for all providers at no cost Every Tuesday at 5:00pm ET Call 866.205.5379, enter passcode 113 29 178, and then press # Additional Resources Cigna Medicare Billing guidelines and telehealth Cigna Dental Interim Communication to Providers QualCare Workers Compensation Interim billing guidance No. Emotional health resources have been added to the COVID-19 interim guidance page for behavioral providers at CignaforHCP.com. Free Account Setup - we input your data at signup. This is an extenuating circumstance. Yes. 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. Diluents are not separately reimbursable in addition to the administration code for the infusion. What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? For other laboratory tests when COVID-19 may be suspected. The interim COVID-19 virtual care guidelines as outlined on this page were in place for dates of service through December 31, 2020. Cigna follows CMS rules related to the use of modifiers. Yes. 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 (whether billed on the same or different claims). Cigna Telehealth Place of Service Code: 02 Cigna Telehealth CPT Code Modifier: 95 We charge a percentage of the allowed amount per paid claim (only paid claims) No per claim submission fee No annual or monthly subscription fee We continue to make several other accommodations related to virtual care until further notice. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. 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. We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. These codes are used to report episodes of patient care initiated by an established patient or guardian of an established patient. This eases coordination of benefits and gives other payers the setting information they need. 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 generally takes place in a mass immunization setting, such as, a public health center, pharmacy, or mall but may include a physician office setting. M misstigris Networker Messages 63 Location Portland, OR Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Informing Cigna prior to delivering services in other states can help to ensure claims are adjudicated correctly when submitted with addresses in states other than the provider's usual location. For additional information about our coverage of the COVID-19 vaccine, please review our. Yes. 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. 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. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. Codes on the list of approved telehealth services allow for various settings, but there must be both audio and video in real time between the physician . 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. Intake / Evaluation (90791) Billing Guide, Evaluation with Medical Assessment (90792). Comprehensive Outpatient Rehabilitation Facility. Cigna did not make any requirements regarding the type of technology used for virtual care through December 31, 2020 (i.e., phone, video, FaceTime, Skype, etc. Telehealth services not billed with 02 will be denied by the payer. 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. Standard cost-share will apply for the customer, unless waived by state-specific requirements. In order to bill these codes, the test must be FDA approved or cleared or have received Emergency Use Authorization (EUA). Refer to the Telemedicine Website for a list of billing codes which may be used with Place of Service (POS) 02 or 10. However, facilities will not be penalized financially for failure to notify us of admissions. Every provider we work with is assigned an admin as a point of contact. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. (Description change effective January 1, 2016). 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 will generally not cover in-vitro molecular, antigen, or antibody tests for asymptomatic individuals. To this end, we will use all feedback we receive to consider further updates to our policy. Note: This article was updated on January 26, 2022, for clarification purposes. Providers should append the GQ, GT, or 95 modifier and Cigna will reimburse them consistent with their face-to-face rates. To speak with a dentist,log in to myCigna. Download and . 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. 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. UnitedHealthcare (UHC) is now requiring physicians to bill eligible telehealth services with place of service (POS) 02 for commercial products. 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. They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. EAP sessions are allowed for telehealth services. As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. When multiple services are billed along with S9083, only S9083 will be reimbursed. Non-contracted providers should use the Place of Service code they would have used had the . Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. This code will only be covered where state mandates require it. You get connected quickly. MLN Matters article MM12549, CY2022 telehealth update Medicare physician fee schedule. Activate your myCigna account nowto get access to a virtual dentist. Thank you. Hi Laelia, I'd be happy to help. 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. 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). At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. *Please Note: virtual check-in and E-visit codes must be billed with Place of Service (POS) 02 and modifier GT. Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. Claims must be submitted on a CMS-1500 form or electronic equivalent. .gov We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). Share sensitive information only on official, secure websites. We are your billing staff here to help. Cigna understands the tremendous pressure our healthcare delivery systems are under. If specimen collection and a laboratory test are billed together, only the laboratory test will be reimbursed. 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. 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. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. POS 02: Telehealth Provided Other than in Patient's Home Yes. 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. Area (s) of Interest: Payor Issues and Reimbursement. Yes. No. 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. 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. No. Product availability may vary by location and plan type and is subject to change. In these cases, the non-credentialed provider can bill under the group assuming they are practicing within state laws to administer the vaccine. or 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.