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. POS codes are two-digit codes reported on . Yes. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. 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. No. Most mental health providers will be furnishing services using Place of Service code 10 (POS 10) when providing telehealth services. Effective Jan 1, 2022, the CMS changed the definition of POS code 02 we've been using for telehealth, and introduced a second telehealth POS code 10: POS 10: Telehealth to a client located at home (does not apply to clients in a hospital, nursing home or assisted living facility) POS 02: Telehealth to a client who is not located at home If a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. A federal government website managed by the For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. CMS officially has designated a Place of Service code for all of the telehealth to be "02" starting April 1, 2020. All other customers will have the same cost-share as if they received the services in-person from that same provider. 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. 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. Billing guidelines: Optum Behavioral Health will reimburse telehealth services which use standard CPT codes and a GT modifier or a Place of Service of 02 for This guidance applies to all providers, including laboratories. When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance. incorporated into a contract. Get non-narcotic prescriptions sent directly to your local pharmacy, if appropriate. Please note that we continue to request that providers do not bill with modifiers 93 or FQ at this time. Approximately 98% of reviews are completed within two business days of submission. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. These codes do not need a place of service (POS) 02 or modifier 95 or GT. Note that billing B97.29 will not waive cost-share. Urgent Care vs. the Emergency Room7 Ways to Help Pay Less for Out-of-Pocket Costs, What is Preventive Care?View all articles. For example, an infectious disease specialist could provide a virtual consultation for an ICU patient, document the level of care provided, bill the appropriate face-to-face E&M code with modifier GQ, GT, or 95, and be reimbursed at the face-to-face rate. A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. Treatment is supportive only and focused on symptom relief. This coverage began January 15, 2022 and continues through at least the end of the public health emergency (PHE) period (May 11, 2023). Telehealth Place of Service Code: Telehealth Reimbursement We understand that it's important to actually be able to speak to someone about your billing. Washington, D.C. 20201 For services where COVID-19 is not the initial clinical presentation (e.g., appendectomy, labor and delivery, etc. 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. No. 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. PDF Cigna'S Virtual Care Reimbursement Policy You get connected quickly. Cigna will cover the administration of the COVID-19 vaccine with no customer cost-share even when administered by a non-participating provider following the guidance above. Yes. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. We will continue to monitor inpatient stays. Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. Must be performed by a licensed provider. We also continue to make several additional accommodations related to virtual care until further notice. Therefore, FaceTime, Skype, Zoom, etc. 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. If the patient is in their home, use "10". Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. 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]). codes and normal billing procedures. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. A facility which primarily provides to residents skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care services above the level of custodial care to other than individuals with intellectual disabilities. All synchronous technology used must be secure and meet or exceed federal and state privacy requirements. Services include physical therapy, occupational therapy, and speech pathology services. 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. mitchellde True Blue Messages 13,505 Location Columbia, MO Best answers 2 Mar 9, 2020 #2 Those are the codes for a phone visit. For a complete list of billing requirements, please review the Virtual Care Reimbursement Policy. Yes. PDF FAQs for Illinois Medicaid Virtual Healthcare Expansion/Telehealth 3. For all other IFP plans outside of Illinois, primary care physicians are still encouraged to coordinate care and assist in locating in-network specialists, but the plans no longer have referral requirements as of January 1, 2021. No. 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. ), 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. "All Rights Reserved." This website and its contents may not be reproduced in whole or in part without . Providers could deliver any face-to-face service on their fee schedule virtually, including those not related to COVID-19, for dates of service through December 31, 2020. For services included in our Virtual Care Reimbursement Policy, a number of general requirements must be met for Cigna to consider reimbursement for a virtual care visit. 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) (This code is available for use immediately with a final effective date of May 1, 2010), A location, not described by any other POS code, owned or operated by a public or private entity where the patient is employed, and where a health professional provides on-going or episodic occupational medical, therapeutic or rehabilitative services to the individual. 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. (Receive an extra 25% off with payment made by Mastercard.) GT Modifiers & CPT Codes for Telemedicine Guide | Healthie Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication). When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. eConsult services remain covered; however, customer cost-share applies as of January 1, 2022. Secure .gov websites use HTTPSA 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. Cigna allows modifiers GQ, GT, or 95 to indicate virtual care for all services. We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice. New/Modifications to the Place of Service (POS) Codes for Telehealth 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). TheraThink.com 2023. ) Further, we will 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. This article was updated on March 28, 2020 by adding a link to American Specialty Health and updating the place of service code to use on the 1500-claim form. 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. As always, we remain committed to ensuring that: Yes. No. Every provider we work with is assigned an admin as a point of contact. While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF). Telehealth Reimbursement Alert: 2022 Telehealth CPT Codes Released In addition, it's my interpretation that Cigna is only paying for telehealth services for physical, occupational and speech therapy submitted on a 1500-claim form by a private practice. 1. The Outbreak Period is a period distinct from the COVID-19 public health emergency (PHE), which applies to other COVID-related relief measures, such as no-cost share coverage of COVID-19 testing. 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. Services include methadone and other forms of Medication Assisted Treatment (MAT). Once completed, telehealth will be added to your Cigna specialty. The interim COVID-19 virtual care guidelines as outlined on this page were in place for dates of service through December 31, 2020. that insure or administer group HMO, dental HMO, and other products or services in your state). Official websites use .govA PDF Optum Behavioral Health: COVID-19 updates to telehealth policies Federal government websites often end in .gov or .mil. Claims were not denied due to lack of referrals for these services during that time. (Description change effective January 1, 2016). Talk directly to board-certified providers 24/7 by video or phone for help with minor, non-life-threatening medical conditions1. In these cases, providers should bill their regular face-to-face codes that are on their fee schedule, and add the GQ, GT, or 95 modifier to indicate the services were performed virtually. EAP sessions are allowed for telehealth services. When specific contracted rates are in place for diagnostic COVID-19 tests, Cigna will reimburse covered services at those contracted rates. To help remove any barriers to receive testing, Cigna will cover any diagnostic molecular or antigen diagnostic test for COVID-19, including rapid tests and saliva-based tests, through at least May 11, 2023. Cigna will waive all customer cost-share for diagnostic services, testing, and treatment related to COVID-19, as follows: The visit will be covered without customer cost-share if the provider determines that the visit was consistent with COVID-19 diagnostic purposes. Cigna will not make any limitation as to the place of service where an eConsult can be used. Instead, U07.1, J12.82, M35.81, or M35.89 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnosis. Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. Yes. Services not related to COVID-19 will have standard customer cost-share. Emergent transport to nearby facilities capable of treating customers is covered without prior authorization. M0222 (administration in facility setting): $350.50, M0223 (administration in home setting): $550.50. However, facilities will not be penalized financially for failure to notify us of admissions. Providers should bill one of the above codes, along with: No. Is Face Time allowed? Cigna Telehealth Service eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. Obtain your Member Code with just HK$100. Telehealth Visits | AAFP Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. A facility whose primary purpose is education. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. Diagnostic tests, which indicate if the individual carries the virus and can infect others, Serology (i.e., antibody) tests, which indicate if the individual had a previous infection and has now potentially developed an immune response, An individual seeks and receives a COVID-19 diagnostic test from a licensed or authorized health care provider; or, A licensed or authorized health care provider refers an individual for a COVID-19 diagnostic test; and, The laboratory test is FDA approved or cleared or has received Emergency Use Authorization (EUA); and, The test is run in a laboratory, office, urgent care center, emergency room, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU; and, The results of a molecular or antigen test are non-diagnostic for COVID-19 and 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); and. COVID-19: Billing & Coding FAQs for Aetna Providers Therefore, as of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. Issued by: Centers for Medicare & Medicaid Services (CMS). Cigna covers C9803 with no customer cost-share for a hospital outpatient clinic visit specimen collection, including drive-thru tests, through at least May 11, 2023 only when billed without any other codes. Per usual policy, Cigna does not require three days of inpatient care prior to transfer to a SNF. A facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters). CMS Place of Service Code Set | Guidance Portal - HHS.gov Cigna covers pre-admission and pre-surgical COVID-19 testing with no customer cost-share when performed in an outpatient setting through at least May 11, 2023. Certain PT, OT, and ST virtual care services remain reimbursable under the R31 Virtual Care Reimbursement Policy. Listing Results Cigna Telehealth Place Of Service. We maintain all current medical necessity review criteria for virtual care at this time. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. New POS codes Jan 2022 - Navigating the Insurance Maze Yes. 24/7, live and on-demand for a variety of minor health care questions and concerns. We continue to make several other accommodations related to virtual care until further notice. Cost-share was waived through February 15, 2021 dates of service. The ordering provider should use the standard, existing process to submit home health orders to eviCore healthcare. 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. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. Comprehensive Inpatient Rehabilitation Facility. The covered procedure codes for E-visits/online portal services include: 99421, 99422, 99423, G2061, G2062, G2063. POS 02: Telehealth Provided Other than in Patient's Home Audio-only encounters can be provided using the telephone evaluation and management codes (CPT codes. Yes. 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. We recommend providers bill POS 02 beginning July 1, 2022 for virtual services (instead of a face-to-face POS). For virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02. As of April 4, 2022, individuals with Medicare Part B and Medicare Advantage plans can get up to eight OTC tests per calendar month from participating pharmacies and health care providers for the duration of the COVID-19 public health emergency (PHE). Cigna may not control the content or links of non-Cigna websites. A short term accommodation such as a hotel, camp ground, hostel, cruise ship or resort where the patient receives care, and which is not identified by any other POS code. 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. What place of service code should be used for telemedicine services? Please note that customer cost-share and out-of-pocket costs may vary for services customers receive through our virtual care vendor network (e.g., MDLive). If a provider 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. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. BCBSNC Telehealth Corporate Reimbursement Policy CIGNA Humana Humana Telehealth Expansion 03/23/2020 Humana provider FAQs Medicaid Special Bulletin #28 03/30/2020 (Supersedes Special Bulletin #9) Medicare Telemedicine Provider Fact Sheet 03/17/2020 Medicare Waivers 03.30.2020 PalmettoGBA MLN Connects Special Edition - Tuesday, March 31, 2020 200 Independence Avenue, S.W. 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. .gov 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. In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. Providers will not need a specific consent from patients to conduct eConsults. ( Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. Providers should bill the relevant vaccine administration code (e.g., 0001A, 0002A, etc.) Activate your myCigna account nowto get access to a virtual dentist. Cigna will determine coverage for each test based on the specific code(s) the provider bills. Telehealth (also referred to as telemedicine) gives our members access to their health care provider from their home or another location. Summary of Codes for Use During State of Emergency. 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.