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Area (s) of Interest: Payor Issues and Reimbursement. 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. Comprehensive Inpatient Rehabilitation Facility. Similar to other vaccination administration (e.g., a flu shot), an E&M service and vaccine administration code should only be billed when a significant and separately identifiable E&M visit was performed at the same time as the administration of the vaccine. Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. 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. Providers can call Cigna customer service at 1.800.88Cigna (882.4462) to check a patients eligibility information, including if their plan offers coverage for these purposes. Listed below are place of service codes and descriptions. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). Cigna commercial and Cigna Medicare Advantage customers receive the COVID-19 vaccine with no out-of-pocket costs; and. The Virtual Care Reimbursement Policy also applies to non-participating providers. For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. TheraThink.com 2023. 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 M misstigris Networker Messages 63 Location Portland, OR . Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other . For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. Specialist to specialist (e.g., ophthalmologist requesting consultation from a retina specialist, orthopedic surgeon requesting consultation from an orthopedic surgeon oncologist, cardiologist with an electrophysiology cardiologist, and obstetrician from a maternal fetal medicine specialist), Hospitalist requests an infectious disease consultation for pulmonary infections to guide antibiotic therapy, The ICD-10 code that represents the primary condition, symptom, or diagnosis as the purpose of the consult; and. 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. Place of Service 02 will reimburse at traditional telehealth rates. If a provider was reimbursed for a face-to-face service per their existing fee schedule, then they were reimbursed the same amount even if they delivered the service virtually. 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 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. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. Other Reimbursement Type. This new initiative enables payment from original Medicare for submitted claims directly to participating eligible pharmacies and other health care providers, which allows Medicare beneficiaries to receive tests at no cost. 1 In an emergency, always dial 911 or visit the nearest hospital. 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. 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. 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 allow commercial and behavioral providers who are participating with Cigna (and who have up-to-date credentialing) to provide in-person or virtual care in other states to the extent that the scope of the license and state regulations allow such care to take place. representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). Usually not. All Rights Reserved. As of February 16, 2021 dates of service, these treatments remain covered, but with standard customer cost-share. This eases coordination of benefits and gives other payers the setting information they need. Issued by: Centers for Medicare & Medicaid Services (CMS). When specific contracted rates are in place for COVID-19 vaccine administration services, Cigna will reimburse covered services at those contracted rates. 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. Under normal circumstances, the provider would bill with the Place of Service code 2, to indicate the care was rendered via telehealth. Telehealth services not billed with 02 will be denied by the payer. No. Routine and non-emergent transfers to a secondary facility continue to require authorization. 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. Because health care providers are the most trusted source of information for consumers who are hesitant about receiving the vaccine, we continue to encourage providers to proactively educate their patients especially those who may have vaccine hesitancy or who are at high-risk of severe COVID-19 illness on the safety, effectiveness, and availability of the vaccine. The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. (99441, 98966, 99442, 98967, 99334, 98968). Modifier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): . POS 11, 19 and 22) modifier GT or 95 (or GQ for Medicaid) must be used. Yes. 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. When billing for the service, indicate the place of service as where the visit would have occurred if in person. 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. 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. Separate codes providers may use to bill for supplies are generally considered incidental to the overall primary service and are not reimbursed separately. Providers will not need a specific consent from patients to conduct eConsults. When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. A serology test is a blood test that measures antibodies. Following the recent statement from the National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel indicating that a three-dose regimen of Remdesivir in the outpatient setting can be effective in preventing progression to severe COVID-19, CMS created HCPCS code J0248 when administering Remdesivir in an outpatient setting. Standard customer cost-share applies. Cigna covers FDA EUA-approved laboratory tests. 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. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. No additional modifiers are necessary. When all requirements are met, covered services are currently reimbursed at 100% of face-to-face rates (i.e., parity). 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. 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. No. Throughout the pandemic, the emergency use authorized monoclonal antibody drug bebtelovimab was purchased by the federal government and offered to providers for free. 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 admitted as inpatients or outpatients. Intermediate Care Facility/ Individuals with Intellectual Disabilities. Cigna does not require prior authorization for home health services. Telehealth claims with any other POS will not be considered eligible for reimbursement. Last updated February 15, 2023 - Highlighted text indicates updates. Per CMS, U0003 and U0004 should be used to bill for tests that would typically be billed by 87635 and U0002 respectively, except for when the tests are performed with these high-throughput technologies. To receive payment equivalent to a normal face-to-face visit you will not bill POS 2 and instead will follow Medicare guidance to bill POS 11 as if care was delivered in the office during COVID-19. Neither U0003 nor U0004 should be used for tests that are used to detect COVID-19 antibodies. Modifier 95, GT, or GQ must be appended to the appropriate CPT or HCPCS procedure code(s) to indicate the service was for virtual care. At a minimum, we will always follow Centers for Medicare & Medicaid Services (CMS) telehealth or state-specific requirements that apply to telehealth coverage for our insurance products. For more information, please visit Cigna.com/Coronavirus. Here is a complete list of place of service codes: Place of Service Codes. Yes. 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. We continue to make several other accommodations related to virtual care until further notice. Please note that this guidance applies to drive through testing as well, and includes services performed by a free-standing emergency room or any other provider. Providers receive reasonable reimbursement consistent with national CMS rates for administering EUA-approved COVID-19 vaccines. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. When multiple services are billed along with S9083, only S9083 will be reimbursed. It's our goal to ensure you simply don't have to spend unncessary time on your billing. As of February 16, 2021 dates of service, cost-share applies. Note that billing B97.29 will not waive cost-share. 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. Standard cost-share will apply for the customer, unless waived by state-specific requirements. 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. Youll receive a summary of your screening results for your records. Unlisted, unspecified and nonspecific codes should be avoided. Cigna will determine coverage for each test based on the specific code(s) the provider bills. 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. This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. Store and forward communications (e.g., email or fax communications) are not reimbursable. TheraThink provides an affordable and incredibly easy solution. 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.). Customers will be referred to seek in-person care. Reimbursement for codes that are typically billed include: Yes. 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. In addition to the in-office care that you deliver today, we encourage you to consider offering virtual care to your patients with Cigna coverage as well and ensure theyre aware that you can continue to offer ongoing covered virtual care as they need it and as its medically appropriate. Sign up to get the latest information about your choice of CMS topics. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. Telephone codes were added to the list of services that can be billed via telehealth, and the rates for codes 99441-99443 were increased, to match the rates for 99212-99214 Office visit codes must still use two-way audio and visual, real time interactive technologies, but the payment rates for audio only codes (99441-99443) were increased A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided. 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. Yes. Cigna Telehealth Service is a one-stop mobile app for having virtual consultation with doctors in Hong Kong as well as getting Covid-19 self-test kit & medication delivered to your doorstep. A facility which provides room, board and other personal assistance services, generally on a long-term basis, and which does not include a medical component. In addition, Anthem would recognize telephonic-only . means youve safely connected to the .gov website. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. Claims must be submitted on a CMS-1500 form or electronic equivalent. The POS Workgroup is revising the description of POS code 02 and creating a new POS code 10 to meet the overall industry needs, as follows: 1. Schedule an appointment online with MDLIVE and visit a lab for your blood work and biometrics. Talk to board-certified dermatologists without an appointment for customized care for skin, hair, and nail conditions. Yes. 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. If you are rendering services as part of a facility (i.e., intensive outpatient program . Telephone, Internet, or electronic health record consultations of less than five minutes should not be billed. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Yes. Cigna commercial and Cigna Medicare Advantage are waiving the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. If the individual test is not part of a panel, but is part of a series of other pathogen tests that are performed, unbundling edits may apply. 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 . We recommend providers bill POS 02 beginning July 1, 2022 for virtual services (instead of a face-to-face POS). 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). We will continue to monitor inpatient stays. Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. Services include physical therapy, occupational therapy, and speech pathology services. ), Preventive care services (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) [Effective with January 29, 2022 dates of service]. If a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. 3. New/Modifications to the Place of Service (POS) Codes for Telehealth. 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. When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance. No. Through February 15, 2021, Cigna waived customer cost-share for any approved COVID-19 treatment, no matter the location of the service. 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. 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. Cigna will only cover non-diagnostic PCR, antigen, and serology (i.e., antibody) tests when covered by the client benefit plan. Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. This is a key difference between Commercial and Medicare risk . 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. A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. End-Stage Renal Disease Treatment Facility. Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. However, CMS published additional details about their new initiative to cover FDA approved, authorized, or cleared over-the-counter (OTC) COVID-19 tests at no cost. For a complete list of billing requirements, please review the Virtual Care Reimbursement Policy. Phone, video, FaceTime, Skype, Zoom, etc. 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. Beginning January 15, 2022, and through at least the end of the PHE (. Yes. When billing, you must use the most appropriate code as of the effective date of the submission. 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. (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.). When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. Download and . A facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program for patients who do not require full time hospitalization, but who need broader programs than are possible from outpatient visits to a hospital-based or hospital-affiliated facility. You want to know you can call your billing admin, a real person you've already spoken with, and get immediate answers about your claims. (As of 10/14/2020) Where can providers access the telemedicine policy and related codes? When no specific contracted rates are in place, Cigna will reimburse covered services at the established national CMS rates to ensure timely, consistent, and reasonable reimbursement. As always, we remain committed to providing further updates as soon as they become available. 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. No. 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. As of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. Yes. 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. Effective for dates of service on and after March 2, 2020 until further notice, Cigna will cover eConsults when billed with codes 99446-99449, 99451 and 99452 for all conditions. Cigna will not reimburse providers for the cost of the vaccine itself. Yes. Cigna will not make any limitation as to the place of service where an eConsult can be used. 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. 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. 24/7, live and on-demand for a variety of minor health care questions and concerns. What place of service code should be used for telemedicine services? Most mental health providers will be furnishing services using Place of Service code 10 (POS 10) when providing telehealth services. For all Optum Behavioral Health commercial plans, any telehealth services provided via a real-time audio and video communication system can be billed for members at home or another location. To increase convenient 24/7 access to care if a patients preferred provider is unavailable in-person or virtually, our virtual care platform also offers solutions that include national virtual care vendors like MDLive. 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. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. Yes. Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information. Because most standard Cigna client benefit plans do not extend coverage to screening services when performed for employment reasons (e.g., occupational physical examination), virtual care screening services will generally not be covered solely for return-to-work purposes. Antibody tests: 86328, 86769, 86408, 86409, 86413, and 0224U, Cigna covers diagnostic molecular and antigen tests for COVID-19 through at least. Talk privately with a licensed therapist or psychiatrist by appointment using your phone, tablet, or computer. Share sensitive information only on official, secure websites. 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. You'll always be able to get in touch. Is there a code that we can use to bill for this other than 99441-99443? 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). All Time (0 Recipes) Past 24 Hours Past Week Past month. Thanks for your help! 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. If you are looking for more comprehensive implementation . 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. Preventive care checkups and wellness screenings available at no additional cost, Routine care visits allow you to build a relationship with the same primary care provider (PCP) to helpmanage conditions, Prescriptions available through home delivery orat local pharmacies, if appropriate, Receive orders for biometrics, blood work andscreenings at local facilities, Skin conditions such as rashes, moles, eczema, and psoriasis, Care for hundreds of minor medical conditions, A convenient and affordable alternative to urgent, Schedule an appointment that works for you, You have the option to select the same provider for every session, Get prescriptions sent directly to your local pharmacy, if appropriate. In these cases, the urgent care center should append a GQ, GT, or 95 modifier, and we will reimburse the full face-to-face rate for insured and Non-ERISA ASO customers in states where telehealth parity laws exist. .gov Please review the Virtual care services frequently asked questions section on this page for more information. 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. Therefore, effective with August 15 dates of service, Cigna will reimburse providers consistent with CMS rates for doses of bebtelovimab that they purchase directly from the manufacturer. Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. Note: This article was updated on January 26, 2022, for clarification purposes. 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. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. 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. At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. April 14, 2021. Denny and his team are responsive, incredibly easy to work with, and know their stuff. The provider will need to code appropriately to indicate COVID-19 related services. Please review these changes by going to the Provider FastFax page and selecting fax number 30. Yes, the cost-share waiver for COVID-19 treatment ended on February 15, 2021. No. Other place of service not identified above. ICD-10 code U07.1, J12.82, M35.81, or M35.89. Additionally, Cigna also continues to provide coverage for COVID-19 tests that are administered with a providers involvement or prescription after individualized assessment as outlined in this section and in Cignas COVID-19 In Vitro Diagnostic Testing coverage policy.