For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. Per CMS, individuals without health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost. While the R31 Virtual Care Reimbursement Policy that went into effect on January 1, 2021 only applies to claims submitted on a CMS-1500 claim form, we will continue to reimburse virtual care services billed on a UB-04 claim form until further notice when the services: Please note that existing reimbursement policies will apply and may affect claims payment (e.g., R30 E&M Services). Most mental health providers will be furnishing services using Place of Service code 10 (POS 10) when providing telehealth services. Listed below are place of service codes and descriptions. Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004. 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. 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. This includes: Please refer to the interim COVID-19 virtual care guidelines for a complete outline of our interim COVID-19 virtual care coverage. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. 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. or 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. Speak with a provider online and discuss your lab work, biometric screenings. Services include physical therapy, occupational therapy, and speech pathology services. A facility which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital. Evernorth Provider - Resources - COVID-19: Interim Guidance 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. Cigna Telehealth Service Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication). How Can You Tell Which Specific Technology is Reimbursable? Services include methadone and other forms of Medication Assisted Treatment (MAT). Cigna will determine coverage for each test based on the specific code(s) the provider bills. Billing an evaluation and management (E/M) code when that level of service is not provided is fraudulent billing and is expressly prohibited. Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. PDF INTERIM TELEHEALTH GUIDANCE - Integrated Health Care 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. No. If a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. When specimen collection is done in addition to other services on the same date of service for the same patient, reimbursement will not be made separately for the specimen collection (when billed on the same or different claims). Yes. 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. The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place at least until the end of Public Health Emergency (PHE) period. A location where providers administer pneumococcal pneumonia and influenza virus vaccinations and submit these services as electronic media claims, paper claims, or using the roster billing method. A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services rendered by, or under the supervision of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients. In compliance with federal agency guidance, however, Cigna covers individualized COVID-19 diagnostic tests without cost-share through at least May 11, 2023 for asymptomatic individuals when referred by or administered by a health care provider. Cigna Telehealth Place of Service Code: 02. Cigna recommends video services but allows telephonic sessions; however they may require review for medical necessity. 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. For telephone services only, codes are time based. Cigna will reimburse at 100% of face-to-face rates, even when billing POS 02. Reimbursement for the administration of the injection will remain the same. A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. If a patient presents for services other than COVID-19, Cigna will waive cost-share only for the COVID-19 related services (e.g., laboratory test). 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 April 14, 2021. 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. For example, if a patient presents at an emergency room with a suspected broken ankle after a fall and is also tested for COVID-19 during the visit, Cigna would cover services related to treating the ankle at standard customer cost-share, while the COVID-19 laboratory test would be covered at no customer cost-share. Non-contracted providers should use the Place of Service code they would have used had the . For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. ), Preventive care services (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) [Effective with January 29, 2022 dates of service]. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. 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 4 Due to state laws governing teledentistry, this service is not available to residents of Texas. For details, see the CMS document titled Place of Service Codes for Professional Claims Database (updated September 2021). POS 02: Telehealth Provided Other than in Patient's Home In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. For more information, see the resources along the right-hand side of the screen. Consistent with federal guidelines for private insurers, Cigna commercial will cover up to eight over-the-counter (OTC) diagnostic COVID-19 tests per month (per enrolled individual) with no out-of-pocket costs for claims submitted by a customer under their medical benefit. The U.S. Food and Drug Administration (FDA) recently approved for emergency use two prescription medications for the treatment of COVID-19: PaxlovidTM (from Pfizer) and molnupiravir (from Merck). No. Providers that administer vaccinations to patients without health insurance or whose insurance does not provide coverage of vaccination administration fees, may be able to file a claim with the provider relief fund, but may not charge patients directly for any vaccine administration costs. 3. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. Yes. For example, talking to a board-certified doctor for a minor medical issue costs less than an ER or urgent care center, and may even be less than an in-office Primary Care Provider (PCP) visit. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. CPT 99490 covers at least 20 minutes of non-face-to-face chronic care management services provided by clinical staff. Store and forward communications (e.g., email or fax communications) are not reimbursable. On-demand virtual care for minor medical conditions, Talk therapy and psychiatry from the privacyof home. Service codes Physicians: use service codes 99441-99443; Non-physicians: use 98966-98968 We're waiving copays for telehealth visits for behavioral and mental health counseling for members eligible for managed long-term services and supports (MLTSS) and Division of Developmental . This code will only be covered where state mandates require it. We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information. As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. You can call, text, or email us about any claim, anytime, and hear back that day. Cigna will factor in the current strain on health care systems and will incorporate this information into retrospective reviews. TheraThink.com 2023. Providers should append the GQ, GT, or 95 modifier and Cigna will reimburse them consistent with their face-to-face rates. Services may be rendered via telemedicine when the service is: A covered Health First Colorado benefit, Within the scope and training of an enrolled provider's license, and; Appropriate to be rendered via telemedicine. Place of Service 02 in Field 24-B (see sample claim form below) For illustrative purposes only. Intake / Evaluation (90791) Billing Guide, Evaluation with Medical Assessment (90792). You'll always be able to get in touch. Certain virtual care services that were previously covered on an interim basis as part of our COVID-19 guidelines are now permanently covered as part of our Virtual Care Reimbursement Policy. 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. The Administration's plan is to end the COVID-19 public health emergency (PHE) on May 11, 2023. Unless telehealth requirements are . This means that providers could perform services for commercial Cigna medical customers in a virtual setting and bill as though the services were performed face-to-face. All health insurance policies and health benefit plans contain exclusions and limitations. Before sharing sensitive information, make sure youre on a federal government site. Routine and non-emergent transfers to a secondary facility continue to require authorization. These codes should be used on professional claims to specify the entity where service (s) were rendered. 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. When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9. The .gov means its official. 2 Limited to labs contracted with MDLIVE for virtual wellness screenings. An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. Certain PT, OT, and ST virtual care services remain reimbursable under the R31 Virtual Care Reimbursement Policy. 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. We will continue to assess the situation and adjust to market needs as necessary.
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