Please visit CignaforHCP.com/virtualcare for additional information about that policy. As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. Yes. Specimen collection will only be reimbursed in addition to other services when it is billed by an independent laboratory for travel to a skilled nursing facility (place of service 31), nursing home facility (place of service 32), or to an individuals home (place of service 12) to collect the specimen. 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. Please note that we continue to request that providers do not bill with modifiers 93 or FQ at this time. A federal government website managed by the 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. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. Yes. The test is FDA approved or cleared or have received Emergency Use Authorization (EUA); The test is run in a laboratory, office, urgent care center, emergency room, drive-thru testing site, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU. 31, 2022. On July 2, 2021 MVP announced changes to member cost-share effective August 1, 2021. 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 are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. No authorization is required for the procurement or administration of COVID-19 infusion treatments. 5 Virtual dermatological visits through MDLIVE are completed via asynchronous messaging. Modifier CR or condition code DR can also be billed instead of CS. 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. Yes. For more information, please visit Cigna.com/Coronavirus. Specimen collection centers like these can also bill codes G2023 or G2024 following the preceding guidance. Yes. were all appropriate to use through December 31, 2020. 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) 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. Cigna does not reimburse an originating site of service fee or facility fee for telehealth visits, including for code Q3014, as they are not a covered benefit. Location, other than a hospital or other facility, where the patient receives care in a private residence. Cigna allowed providers to bill a standard face-to-face visit for all virtual care services, including those not related to COVID-19, through December 31, 2020 dates of service. While we will not reimburse the drug itself when a provider receives it free of charge, we request that providers continue to bill the drug on the claim using the CMS code for the specific drug, along with a nominal charge (e.g., $.01), to assist with tracking purposes. 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. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. Yes. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. When the condition being billed is a post-COVID condition, please submit using ICD-10 code U09.9 and code first the specific condition related to COVID-19. 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. Considering the pressure facilities are under, Cigna will extend the authorization approval window from three months to six months on request. Routine and non-emergent transfers to a secondary facility continue to require authorization. Yes, the cost-share waiver for COVID-19 treatment ended on February 15, 2021. 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. Certain home health services can be provided virtually using synchronous communication as part of our R31 Virtual Care Reimbursement Policy. While the policy - announced in United's . In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. Cigna will reimburse providers the full allowed amount of the claim, including what would have been the customer's cost share. A walk-in health clinic, other than an office, urgent care facility, pharmacy or independent clinic and not described by any other Place of Service code, that is located within a retail operation and provides, on an ambulatory basis, preventive and primary care services. Providers should bill the relevant vaccine administration code (e.g., 0001A, 0002A, etc.) 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. Intermediate Care Facility/ Individuals with Intellectual Disabilities. The location where health services and health related services are provided or received, through telecommunication technology. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.). We also continue to make several other accommodations related to virtual care until further notice. 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. Yes. Yes. Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. When a customer receives virtual care services from their regular doctor (or any other provider) as part of this policy and when the provider bills with POS 02 customers with certain benefit plans may have a lower cost-share. For other laboratory tests when COVID-19 may be suspected. When specific contracted rates are in place for COVID-19 vaccine administration services, Cigna will reimburse covered services at those contracted rates. 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. Cigna recommends video services but allows telephonic sessions; however they may require review for medical necessity. 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.). Download and . In order to bill these codes, the test must be FDA approved or cleared or have received Emergency Use Authorization (EUA). Cost-share will be waived for COVID-19 related services only when providers bill the appropriate ICD-10 code and modifier CS. Yes. Cigna may request the appropriate CLIA-certification or waiver as well as the manufacturer and name of the test being performed. Billing the appropriate administration code will ensure that cost-share is waived. Please review the Virtual care services frequently asked questions section on this page for more information. 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. Please note that cost-share still applies for all non-COVID-19 related services. A facility whose primary purpose is education. Urgent care centers will not be reimbursed separately when they bill for multiple services. Generally, only well-equipped commercial laboratories and hospital-based laboratories will have the necessary equipment to offer these tests. This includes when done by any provider at any site, including an emergency room, free-standing emergency room, urgent care center, other outpatient setting, physicians office, etc. This policy applied to customers in the United States who are covered under Cigna's employer/union sponsored insured group health plans, insured plans for US-based globally mobile individuals, Medicare Advantage, and Individual and Family Plans (IFP). Approximately 98% of reviews are completed within two business days of submission. My daily insurance billing time now is less than five minutes for a full day of appointments. While services billed on a UB-04 are out of scope for the new policy, we will continue to evaluate facility-based services for future policy updates. 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. 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. 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. The provider will need to code appropriately to indicate COVID-19 related services. 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. There are two primary types of tests for COVID-19: A serology (i.e., antibody) test for COVID-19 is considered diagnostic and covered without cost-share through at least May 11, 2023 when ALL of the following criteria are met: When specific contracted rates are in place for diagnostic COVID-19 serology tests, Cigna will reimburse covered services at those contracted rates. What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? 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. 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). Yes. Our data is encrypted and backed up to HIPAA compliant standards. The 02 Place of Service code will automatically populate onto your courtesy claims and Superbills when the appointment is scheduled at that location. For more information, see the resources along the right-hand side of the screen. Prior authorization is not required for COVID-19 testing. Psychiatric Facility-Partial Hospitalization. The White House announced the intent to end both the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023. For services where COVID-19 is not the initial clinical presentation (e.g., appendectomy, labor and delivery, etc. No. 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. POS codes are two-digit codes reported on . The site is secure. The accelerated credentialing accommodation ended on June 30, 2022. 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. Reimbursement, when no specific contracted rates are in place, are as follows: No. 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 maintain all current medical necessity review criteria for virtual care at this time. ICD-10 diagnosis codes that generally reflect non-covered services are as follows. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. codes and normal billing procedures. 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. Intake / Evaluation (90791) Billing Guide, Evaluation with Medical Assessment (90792). No. 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. 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. A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. website belongs to an official government organization in the United States. https:// A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Diluents are not separately reimbursable in addition to the administration code for the infusion. A serology test is a blood test that measures antibodies. 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 with January 1, 2021 dates of service, we implemented a new Virtual Care Reimbursement Policy. An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. Official websites use .govA 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. MVP will email or fax updates to providers and will update this page accordingly. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. 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. Through March 31, 2021, if the customer already had an approved authorization request for the service, another precertification request was not needed if the patient is being referred to another similar participating provider that offers the same level of care (e.g., getting a CT scan at another facility within the same or separate facility group). Please review these changes by going to the Provider FastFax page and selecting fax number 30. These codes do not need a place of service (POS) 02 or modifier 95 or GT. Unlisted, unspecified and nonspecific codes should be avoided. 1 Note that billing B97.29 will not waive cost-share. Antibody tests: 86328, 86769, 86408, 86409, 86413, and 0224U, Cigna covers diagnostic molecular and antigen tests for COVID-19 through at least. COVID-19 OTC tests used for employment, travel, participation in sports or other activities are not covered under this mandate. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. Diagnoses requiring testing cannot be confirmed. When no specific contracted rates are in place, Cigna will reimburse all covered COVID-19 diagnostic tests consistent with CMS reimbursement to ensure consistent, timely, and reasonable reimbursement. When no specific contracted rates are in place, Cigna will reimburse the administration of all covered COVID-19 vaccines at the established national CMS rates noted below when claims are billed under the medical benefit to ensure timely, consistent, and reasonable reimbursement. A facility, other than a patient's home, in which palliative and supportive care for terminally ill patients and their families are provided. Billing Guidelines: Optum will reimburse telehealth services which use standard CPT codes for outpatient treatment and a GT, GQ or 95 modifier for either a video-enabled virtual visit or a telephonic session, to indicate the visit was conducted remotely. How Can You Tell Which Specific Technology is Reimbursable? Please note that Cigna temporarily increased the precertification approval window for all elective inpatient and outpatient services - including advanced imaging - from three months to six months for dates of authorization beginning March 25, 2020 through March 31, 2021. 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. 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. incorporated into a contract. 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. (Receive an extra 25% off with payment made by Mastercard.) All synchronous technology used must be secure and meet or exceed federal and state privacy requirements. (Effective January 1, 2020). To this end, we will use all feedback we receive to consider further updates to our policy. Please review the Virtual Care Reimbursement Policy for additional details on the added codes. 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. PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. Total 0 Results. HIPAA does not require patient consent for consultation and coordination of care with health care providers in the ordinary course of treatment for their patients. If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice. For telehealth, the 95 modifier code is used as well. As always, we remain committed to providing further updates as soon as they become available. This will help us to meet customers' clinical needs and support safe discharge planning. **, Watch this short video to learn more about virtual care with MDLivefor Cigna.(Length: 00:01:33). Specimen collection will only be reimbursed in addition to other services when it is billed by an independent laboratory for travel to a skilled nursing facility (place of service 31), nursing facility (place of service 32), or to an individuals home (place of service 12) to collect the specimen. In certain cases, yes. . The codes may only be billed once in a seven day time period. We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information. ), Preventive care services (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) [Effective with January 29, 2022 dates of service]. Yes. (99441, 98966, 99442, 98967, 99334, 98968). 4 Due to state laws governing teledentistry, this service is not available to residents of Texas. This is an extenuating circumstance. We continue to make several other accommodations related to virtual care until further notice. Is there a code that we can use to bill for this other than 99441-99443? Therefore, we will not enforce an administrative denial for failure to secure authorization (FTSA)on appeal if an extenuating circumstance due to COVID-19 applied. All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02. Cigna does require prior authorization for fixed wing air ambulance transport. Cigna will cover Evusheld when administered for the prevention of COVID-19 in certain adults and pediatric individuals consistent with FDA EUA guidance and Cigna's Drug and Biologics Coverage Policy, effective with dates of service on and after December 8, 2021.Please note that Cigna does not require prior authorization for the use or administration of Evusheld. identify telehealth or telephone (audio only) services that were historically performed in the office or other in person setting (E.g. Standard cost-share will apply for the customer, unless waived by state-specific requirements. Telehealth (also referred to as telemedicine) gives our members access to their health care provider from their home or another location. Telephone, Internet, or electronic health record consultations of less than five minutes should not be billed. No. April 14, 2021. Reimbursement will be consistent as though they performed the service in a face-to-face setting. Through December 31, 2020 dates of service, providers could deliver virtual neuropsychological and psychological testing services and bill their regular face-to-face CPT codes that were on their fee schedule . We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. We understand that it's important to actually be able to speak to someone about your billing. When multiple services are billed along with S9083, only S9083 will be reimbursed. Treatment is supportive only and focused on symptom relief. Services provided on and after February 16, 2021 remain covered, but with standard customer cost-share.After the EUA or licensure of each COVID-19 treatment by the FDA, CMS will identify the specific drug code(s) along with the specific administration code(s) for each drug that should be billed. You can call, text, or email us about any claim, anytime, and hear back that day. However, facilities will not be penalized financially for failure to notify us of admissions.
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