Location, other than a hospital or other facility, where the patient receives care in a private residence. 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. 4 Due to state laws governing teledentistry, this service is not available to residents of Texas. 3. 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]). Please note that this list is not all inclusive and may not represent an exact indication match. (Effective January 1, 2003). Please note that while virtual care services billed on a UB-04 claim will not typically be reimbursed under this policy, we continue to reimburse virtual care services billed on a UB-04 claim form until further notice as a COVID-19 accommodation when the services: Please note that existing reimbursement policies will apply and may affect claims payment (e.g., R30 E&M Services). To speak with a dentist,log in to myCigna. M misstigris Networker Messages 63 Location Portland, OR Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. Modifier CR or condition code DR can also be billed instead of CS. Therefore, as of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. Our newest Playbook in the series focuses on the implementation of telehealth (PDF), defined as real-time, audio-visual visits between a clinician and patient. While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. If the individual COVID-19 related diagnostic test(s) are included in a laboratory panel code, only the code for the panel test will be reimbursed. Yes. For additional information about our Virtual Care Reimbursement Policy, providers can contact their provider representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). 3 Biometric screening experience may vary by lab. 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. Per usual protocol, emergency and inpatient imaging services do not require prior authorization. Free Account Setup - we input your data at signup. . These codes do not need a place of service (POS) 02 or modifier 95 or GT. The accelerated credentialing accommodation ended on June 30, 2022. A home health care provider should bill one of the covered home health codes for virtual services (G0151, G0152, G0153, G0155, G0157, G0158, G0299, G0300, G0493, S9123, S9128, S9129, and S9131) along with POS 12 and a GT or 95 modifier to identify that the service(s) were delivered using both an audio and video connection. This will help with tracking purposes, and ensure timely reimbursement for the administration of the treatment. We are actively reviewing all COVID-19 state mandates and will continue to share any changes and more details around coverage, reimbursement, and cost-share as applicable. were all appropriate to use). Other place of service not identified above. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. We added a number of additional codes in March and April 2022 that are now eiligible for reimbursement. (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. If the home health service(s) are done for COVID-19 related treatment, cost-share will be waived for covered services through February 15, 2021 when providers bill ICD-10 code U07.1, J12.82, M35.81, or M35.89. eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. When no specific contracted rates are in place, Cigna will reimburse the administration of all covered COVID-19 vaccines at the established national CMS rates noted below when claims are billed under the medical benefit to ensure timely, consistent, and reasonable reimbursement. MLN Matters article MM12427, New modifications to place of service (POS) codes for telehealth. 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. End-Stage Renal Disease Treatment Facility. Cigna allows modifiers GQ, GT, or 95 to indicate virtual care for all services. Effective January 1, 2022, eConsults remain covered, but cost-share applies for all covered services. U.S. Department of Health & Human Services 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. 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. Services include physical therapy, occupational therapy, and speech pathology services. Yes. mitchellde True Blue Messages 13,505 Location Columbia, MO Best answers 2 Mar 9, 2020 #2 Those are the codes for a phone visit. 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. PT/OT/ST providers could deliver virtual care for any service that was on their fee schedule for dates of service through December 31, 2020. 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). Therefore, FaceTime, Skype, Zoom, etc. Our data is encrypted and backed up to HIPAA compliant standards. Patient is not located in their home when receiving health services or health related services through telecommunication technology. While we will reimburse these services consistent with face-to-face rates, we will monitor the use of level four and five services to limit fraud, waste, and abuse. For a complete list of billing requirements, please review the Virtual Care Reimbursement Policy. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. Add in the unnecessarily difficult insurance billing system and we run the risk of working way over full-time. Providers should bill one of the above codes, along with: No. Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. A medical facility operated by one or more of the Uniformed Services. Billing an evaluation and management (E/M) code when that level of service is not provided is fraudulent billing and is expressly prohibited. For costs and details of coverage, review your plan documents or contact a Cigna representative. 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. 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. 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. We are committed to helping providers deliver care how, when, and where it best meets the needs of their patients. Cost-share is waived only when billed by a provider or facility without any other codes. Please review these changes by going to the Provider FastFax page and selecting fax number 30. Obtain your Member Code with just HK$100. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. Cigna will closely monitor and audit claims for inappropriate services that should not be performed virtually (including but not limited to: acupuncture, all surgical codes, anesthesia, radiology services, laboratory testing, administration of drugs and biologics, infusions or vaccines, EEG or EKG testing). NOTE: As of March 2020, Cigna has waived their attestation requirements however we always recommend calling Cigna or any insurance company to complete an eligibility and benefits verification to ensure your telehealth claims will process through to completion. on the guidance repository, except to establish historical facts. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. 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. What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? For telehealth, the 95 modifier code is used as well. 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. INTERIM TELEHEALTH GUIDANCE Announcement from Cigna Behavioral Health . When administered consistently with Cigna's Drug and Biologics policy and EUA usage guidelines, Cigna will reimburse the infusion and post-administration monitoring of the listed treatments at contracted rates when specific contracted rates are in place for COVID-19 services. A facility whose primary purpose is education. Thank you. ICD-10 diagnosis codes that generally reflect non-covered services are as follows. And as your patients 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. COVID-19 OTC tests used for employment, travel, participation in sports or other activities are not covered under this mandate. Yes. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other . 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. (Description change effective January 1, 2016). 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. 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. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. Deliver services that are covered by the Virtual Care Reimbursement Policy; Bill consistently with the requirements of the policy; and. 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. In addition, these requirements must be met: This guidance applies for all providers, including urgent care centers and emergency rooms, and applies to customers enrolled in Cigna's employer-sponsored plans in the United States and the Individual & Family plans available through the Affordable Care Act. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing. All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02. New/Modifications to the Place of Service (POS) Codes for Telehealth This Change Request implements a new POS code (10) for Telehealth, as well as modifies the description for the existing POS code (02) for Telehealth. TheraThink.com 2023. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. Cigna may request the appropriate CLIA-certification or waiver as well as the manufacturer and name of the test being performed. https:// 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 200 Independence Avenue, S.W. Activate your myCigna account nowto get access to a virtual dentist. In such cases, we will review the services provided on appeal for medical necessity to determine appropriate coverage.As a reminder, precertification is not required for the evaluation, testing, or medically necessary treatment of Cigna customers related to COVID-19. For other laboratory tests when COVID-19 may be suspected. Generally, only well-equipped commercial laboratories and hospital-based laboratories will have the necessary equipment to offer these tests. 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. Organizations that offer Administrative Services Only (ASO) plans will be opted in to waiving cost-share for this service as well. Urgent care centers will not be reimbursed separately when they bill for multiple services. No. An official website of the United States government 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.