The COVID-19 billing and reimbursement guidelines that follow are for commercial Cigna medical services, including IFP, unless otherwise noted. Schedule an appointment online with MDLIVE and visit a lab for your blood work and biometrics. Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. 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. As always, we remain committed to providing further updates as soon as they become available. The following Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes are used to bill for telebehavioral and telemental health services and have been codified into the current Medicare Physician Fee Schedule (PFS). 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. No additional modifiers are necessary. Service performed: OEce or other outpatient visit for the evaluation and management of a new patient CPT code billed: 99202 Modier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): 100% of face-to-face rate Customer cost-share: Applies consistent with Please visit. 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. For more information, please visit Cigna.com/Coronavirus. Obtain your Member Code with just HK$100. 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. (As of 01/21/2021) What Common Procedural Technology (CPT) codes should be used for COVID-19 testing? 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. If you are rendering services as part of a facility (i.e., intensive outpatient program . 1 In an emergency, always dial 911 or visit the nearest hospital. Important notes, What the accepting facility should know and do. We are awaiting further billing instructions for providers, as applicable, from CMS. bill a typical face-to-face place of service (e.g., POS 11) . When no specific contracted rates are in place, Cigna will reimburse the administration of all EUA vaccines at the established national CMS rates when claims are submitted under the medical benefit to ensure timely, consistent, and reasonable reimbursement. 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. For more information about current Evernorth Behavioral Health virtual care guidance, please visit CignaforHCP.com > Resources > Behavioral Resources > Doing Business with Cigna > COVID-19: Interim Guidance. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. We added a number of additional codes in March and April 2022 that are now eiligible for reimbursement. At this time, providers who offer virtual care will not be specially designated within our public provider directories. One of our key goals is to help customers connect to affordable, predictable, and convenient care anytime, anywhere. 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. 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. As long as one of these modifiers is included for the appropriate procedure code(s), the service will be considered to have been performed virtually. Cigna continues to reimburse participating providers when they are credentialed to practice medicine per state regulations, have a current contract, and have completed the Cigna credentialing process.Non-participating providers will only be reimbursed if: 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. . Cost-share will be waived for COVID-19 related services only when providers bill the appropriate ICD-10 code and modifier CS. When performing tests for these purposes, providers should bill the appropriate laboratory code (e.g., U0002) following our existing billing guidelines and testing coverage policy, and use the diagnosis code Z02.79 to indicate the test was performed for return-to-work or diagnosis code Z02.0 to indicate the test was performed for return-to-school purposes. Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication). This code will only be covered where state mandates require it. "All Rights Reserved." This website and its contents may not be reproduced in whole or in part without . Services include physical therapy, occupational therapy, and speech pathology services. 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 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). Activate your myCigna account nowto get access to a virtual dentist. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. M0222 (administration in facility setting): $350.50, M0223 (administration in home setting): $550.50. When no contracted rates are in place, Cigna will reimburse covered diagnostic serology laboratory tests consistent with CMS reimbursement, including $42.13 for code 86769 and $45.23 for code 86328, to ensure consistent, timely, and reasonable reimbursement. Talk to board-certified dermatologists without an appointment for customized care for skin, hair, and nail conditions. 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. 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. 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. . Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. No. 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). This will help with tracking purposes, and ensure timely reimbursement for the administration of the treatment. Cigna will reimburse providers the full allowed amount of the claim, including what would have been the customer's cost share. 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. Sign up to get the latest information about your choice of CMS topics. We are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. You free me to focus on the work I love!. DISCLAIMER: The contents of this database lack the force and effect of law, except as As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9. Billing the appropriate administration code will ensure that cost-share is waived. Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Transport between facilities such as hospitals and SNFs and hospitals and Acute Rehab centers is also covered without prior authorization. We will also 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, and EEG or EKG testing). 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). Please note that our interim COVID-19 virtual care guidelines were in place until December 31, 2020. Cigna will reimburse Remdesivir for COVID-19 treatment when administered in inpatient or outpatient settings at the national CMS reimbursement rate (or average wholesale pricing [AWP] if a CMS rate is not available) when the drug costs are not included in case rates or per diems to ensure timely, consistent, and reasonable reimbursement. POS 02: Telehealth Provided Other than in Patient's Home Please review our COVID-19 In Vitro Diagnostic Testing coverage policy for a list of additional services and ICD-10 codes that are generally not covered. We also referenced the current list of covered virtual care codes by the CMS to help inform our coverage strategy. No. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. Yes. The Virtual Care Reimbursement Policy also applies to non-participating providers. Specimen collection is not generally paid in addition to other services on the same date of service for the same patient whether billed on the same or different claims by the same provider. For example, if the Outbreak Period ends March 1, 2023, any service performed on or before that date will have its standard timely filing window begin upon the expiration of the Outbreak Period (here, March 1, 2023). PT/OT/ST providers should continue to submit virtual claims with a GQ, GT, or 95 modifier and POS 02, and they will be reimbursed at their face-to-face rates. MLN Matters article MM12549, CY2022 telehealth update Medicare physician fee schedule. For additional information about our Virtual Care Reimbursement Policy, please review the policy, contact your provider representative, or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). Yes. Yes. 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. 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. A facility whose primary purpose is education. Youll receive a summary of your screening results for your records. Until further notice, we will continue to made additional virtual care accommodations by allowing: eConsults are when a treating health care provider seeks guidance from a specialist physician through electronic means (e.g., phone, Internet, EHR consultation) to help manage care that is beyond the treating health care provider's usual practice.Typical examples include: Yes. Modifier CR or condition code DR can also be billed instead of CS. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board. These codes do not need a place of service (POS) 02 or modifier 95 or GT. To this end, we will use all feedback we receive to consider further updates to our policy. Reimbursement for the administration of the injection will remain the same. 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. For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. Cigna commercial and Cigna Medicare Advantage are waiving the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. 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 Free Account Setup - we input your data at signup. Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. For more information, including details on how you can get reimbursed for these tests from original Medicare when you directly supply them to your patients with Part B or Medicare Advantage plans, please, U0003: $75 per test (high-throughput PCR-based coronavirus test)*, U0004: $75 per test (any technique with high-throughput technology)*, U0005: $25 (when test results are returned within two days)*, Routine and/or executive physicals (Z02.89). eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. An E&M service and COVID-19 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. For costs and details of coverage, review your plan documents or contact a Cigna representative. (99441, 98966, 99442, 98967, 99334, 98968). Through this feedback and research, we developed a list of covered services that we believe are most appropriate to be offered virtually across multiple specialties. Under My Account > Settings > Practice Details, you can select the Insurance Place of Service code associated with sessions held via video. Instead U07.1, J12.82, M35.81, or M35.89 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnoses.Please refer to the general billing guidance for additional information. Yes. COVID-19 OTC tests used for employment, travel, participation in sports or other activities are not covered under this mandate. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically Is there a code that we can use to bill for this other than 99441-99443? The site is secure. In addition, Cigna recognizes and expects that providers will continue to follow their usual business practices regarding onboarding new providers, locum tenens, and other providers brought in to cover practices or increase care during times of high demand. Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004. However, Cigna will still consider requestes for accelerated credentialing on a case-by-case basis. 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. If a hospitalist is the treating provider, they would not be reimbursed for two services on the same day, as only one service is reimbursed per day, regardless of billing method. We did not make any requirements regarding the type of technology used. Cigna will not make any limitation as to the place of service where an eConsult can be used. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. Claims were not denied due to lack of referrals for these services during that time. 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 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. As of June 1, 2021, these plans again require referrals. A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance. 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. Yes. For other laboratory tests when COVID-19 may be suspected. Modifier CS for COVID-19 related treatment. While we encourage PT/OT/ST providers to follow CMS guidance regarding the use of software programs for virtual care, we are not requiring the use of any specific software program at this time. new codes. 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. (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. Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. ** The Benefits of Virtual Care No waiting rooms. Note that billing B97.29 will not waive cost-share. CPT 99490 covers at least 20 minutes of non-face-to-face chronic care management services provided by clinical staff. To sign up for updates or to access your subscriber preferences, please enter your contact information below. This will allow for quick telephonic consultations related to COVID-19 screening or other necessary consults, and will offer appropriate reimbursement to providers for this amount of time. First Page. COVID-19 admissions would be emergent admissions and do not require prior authorizations. As of July 1, 2022, standard credentialing timelines again apply. Listed below are place of service codes and descriptions. ), Preventive care services (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) [Effective with January 29, 2022 dates of service]. Per usual protocol, emergency and inpatient imaging services do not require prior authorization. However, this added functionality is planned for a future update. A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice. Cost-share is waived only when providers bill one of the identified codes. When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). Please review the Virtual care services frequently asked questions section on this page for more information. Note: We only work with licensed mental health providers. Cigna covered the administration and post-administration monitoring of EUA-approved COVID-19 infusion treatments with no customer-cost share for services provided through February 15, 2021. All other customers will have the same cost-share as if they received the services in-person from that same provider. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. Modifier 95, indicating that you provided the service via telehealth. For telehealth services rendered by a facility provider, report the CPT/HCPCS code with the applicable revenue code as would normally be done for an in-person visit, and also append either modifier 95 or GT. Talk directly to board-certified providers 24/7 by video or phone for help with minor, non-life-threatening medical conditions1. 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. 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. An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. It depends upon the clients benefit plan, but as noted above, testing is usually not covered for these purposed because most standard Cigna client benefit plans do not cover non-diagnostic tests for these non-diagnostic reasons. No virtual care modifier is needed given that the code defines the service as an eConsult. We continue to make several other accommodations related to virtual care until further notice. 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. Specimen collection centers like these can also bill codes G2023 or G2024 following the preceding guidance. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. Providers will not need a specific consent from patients to conduct eConsults. 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. 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. Cigna understands the tremendous pressure our healthcare delivery systems are under. 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. 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. Please visit CignaforHCP.com/virtualcare for additional information about that policy. The provider will need to code appropriately to indicate COVID-19 related services. Here is a complete list of place of service codes: Place of Service Codes. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). EAP sessions are allowed for telehealth services. 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. Providers receive reasonable reimbursement consistent with national CMS rates for administering EUA-approved COVID-19 vaccines. Providers billing under an 837P/1500 must include the place of service (POS) code 02 when submitting claims for services delivered via telehealth. April 14, 2021. You get connected quickly. 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 . 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. The ordering provider should use the standard, existing process to submit home health orders to eviCore healthcare. For all virtual care services, providers should bill using a reimbursable face-to-face code, append the GQ, GT or 95 modifier, and use POS 02 as of July 1, 2022. Providers should bill this code for dates of service on or after December 23, 2021. 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.