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 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. Cigna has not lifted precertification requirements for scheduled surgeries. Telehealth services not billed with 02 will be denied by the payer. Reimbursement, when no specific contracted rates are in place, are as follows: No. If a provider typically delivered face-to-face services in a facility setting, that provider could also deliver any appropriate service virtually consistent with existing Cigna policies through December 31, 2020 dates of service. 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. (Effective January 1, 2003). Cigna will reimburse at 100% of face-to-face rates, even when billing POS 02. Yes. Similar to non-diagnostic COVID-19 testing services, Cigna will only cover non-diagnostic return-to-work virtual care services when covered by the client benefit plan. Listing Results Cigna Telehealth Place Of Service. For COVID-19 related screening (i.e., quick phone or video consult): No cost-share for customers through at least, For non-COVID-19 related services (e.g., oncology visit, routine follow-up care): Standard customer cost-share. 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. The additional 365 days added to the regular timely filing period will continue through the end of the Outbreak Period, defined as the period of the National Emergency (which is declared by the President and must be renewed annually) plus 60 days. Effective January 1, 2021, we implemented a new. 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. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. POS 02: Telehealth Provided Other than in Patient's Home Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. 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. 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. Please note that while Cigna Medicare Advantage plans do fully cover the costs for COVID-19 tests done in a clinical setting, costs of at-home COVID-19 tests are not a covered benefit. Most mental health providers will be furnishing services using Place of Service code 10 (POS 10) when providing telehealth services. Effective Jan 1, 2022, the CMS changed the definition of POS code 02 we've been using for telehealth, and introduced a second telehealth POS code 10: POS 10: Telehealth to a client located at home (does not apply to clients in a hospital, nursing home or assisted living facility) POS 02: Telehealth to a client who is not located at home At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. The location where health services and health related services are provided or received, through telecommunication technology. Location, other than a hospital or other facility, where the patient receives care in a private residence. Please note that our interim COVID-19 virtual care guidelines were in place until December 31, 2020. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. A portion of a hospitals main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Providers should bill the relevant vaccine administration code (e.g., 0001A, 0002A, etc.) Important notes: For additional information about Cigna's coverage of medically necessary diagnostic COVID-19 tests, please review the COVID-19 In Vitro Diagnostic Testing coverage policy. We continue to make several other accommodations related to virtual care until further notice. For telehealth, the 95 modifier code is used as well. As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. Reimbursement for the administration of the injection will remain the same. 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). 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. A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. April 14, 2021. All Time (0 Recipes) Past 24 Hours Past Week Past month. for services delivered via telehealth. Please review our R33 COVID-19 Interim Billing Guidelines policy for ICD-10 diagnosis code requirements to have cost-share waived for G2012. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. Additionally, Cigna understands the tremendous pressure our health care delivery systems are under and will factor in the current strain on health care systems and incorporate this information into retrospective coverage reviews. And as customers 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. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. Talk to board-certified dermatologists without an appointment for customized care for skin, hair, and nail conditions. End-Stage Renal Disease Treatment Facility. Other place of service not identified above. New/Modifications to the Place of Service (POS) Codes for Telehealth This Change Request implements a new POS code (10) for Telehealth, as well as modifies the description for the existing POS code (02) for Telehealth. 31, 2022. We also continue to make several other accommodations related to virtual care until further notice. Urgent care centers will not be reimbursed separately when they bill for multiple services. Yes. For the immediate future, we will continue to reimburse virtual care services consistent with face-to-face rates. 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. 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. 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). When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. ) For the R31 Virtual Care Reimbursement Policy, effective January 1, 2021, we continue to not make any requirements regarding the type of synchronous technology used until further notice. These codes should be used on professional claims to specify the entity where service (s) were rendered. We will continue to assess the situation and adjust to market needs as necessary. Thank you. **, Watch this short video to learn more about virtual care with MDLivefor Cigna.(Length: 00:01:33). Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004. Providers receive reasonable reimbursement consistent with national CMS rates for administering EUA-approved COVID-19 vaccines. It remains expected that the service billed is reasonable to be provided in a virtual setting. 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. On July 2, 2021 MVP announced changes to member cost-share effective August 1, 2021. For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice. For additional information about our coverage of the COVID-19 vaccine, please review our. Contracted providers cannot balance bill customers for non-reimbursable codes. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. Modifier 95, GT, or GQ must be appended to the virtual care code(s). Cost-share was waived through February 15, 2021 dates of service. Cigna covers Remdesivir for the treatment of COVID-19 when administered in inpatient or outpatient settings consistent with EUA usage guidelines and Cigna's Drug and Biologic Coverage Policy. 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. This includes: Please refer to the interim COVID-19 virtual care guidelines for a complete outline of our interim COVID-19 virtual care coverage. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. Cigna continues to require prior authorization reviews for routine advanced imaging. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically Cigna will generally not cover molecular, antigen, or antibody tests for asymptomatic individuals when the tests are performed for general population or public health surveillance, for employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19. When no specific contracted rates are in place, we will reimburse this code at $22.99 consistent with CMS pricing to ensure consistent, timely, and reasonable reimbursement. A certified facility which is located in a rural medically underserved area that provides ambulatory primary medical care under the general direction of a physician. 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. However, facilities will not be penalized financially for failure to notify us of admissions. Cost-share will be waived only when providers bill the appropriate ICD-10 code (U07.1, J12.82, M35.81, or M35.89). That is why in 2015, CMS began reimbursing providers for a program called non-complex Chronic Care Management (CCM), billed as the new code CPT 99490. 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. This is a key difference between Commercial and Medicare risk . Cigna Telehealth Place of Service Code: 02. 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. Non-contracted providers should use the Place of Service code they would have used had the . When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). 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. Transport between facilities such as hospitals and SNFs and hospitals and Acute Rehab centers is also covered without prior authorization. Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication). As a reminder, standard customer cost-share applies for non-COVID-19 related services. Denny and his team are responsive, incredibly easy to work with, and know their stuff. All other customers will have the same cost-share as if they received the services in-person from that same provider. 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. Summary of Codes for Use During State of Emergency. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. Claims were not denied due to lack of referrals for these services during that time. There may be limited exclusions based on the diagnoses submitted. The interim COVID-19 virtual care guidelines were solely in place through December 31, 2020, and this new policy took effect on January 1, 2022. Urgent Care vs. the Emergency Room7 Ways to Help Pay Less for Out-of-Pocket Costs, What is Preventive Care?View all articles. Approximately 98% of reviews are completed within two business days of submission. 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 Cigna commercial and Cigna Medicare Advantage customers receive the COVID-19 vaccine with no out-of-pocket costs; and. Comprehensive Outpatient Rehabilitation Facility. "All Rights Reserved." This website and its contents may not be reproduced in whole or in part without . To this end, we appreciate the feedback and deep collaboration weve had with provider groups and medical societies regarding virtual care. Our policy allows for reimbursement of a variety of services typically performed in an office setting that are appropriate to also perform virtually. Please review the Virtual Care Reimbursement Policy for additional details on the added codes. 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. COVID-19 admissions would be emergent admissions and do not require prior authorizations. Whether physicians report the audio-only encounter to a private payer as an office visit (99201-99215) or telephone E/M service (99441-99443) will depend on what the physician is able to document . 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. 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. Services include methadone and other forms of Medication Assisted Treatment (MAT). (Effective January 1, 2020). My cost is a percentage of what is insurance-approved and its my favorite bill to pay each month! 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. 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. 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 . Informing Cigna prior to delivering services in other states can help to ensure claims are adjudicated correctly when submitted with addresses in states other than the provider's usual location. This code will only be covered where state mandates require it. Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. Yes. were all appropriate to use through December 31, 2020. 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. on the guidance repository, except to establish historical facts. Please review these changes by going to the Provider FastFax page and selecting fax number 30. eConsult services remain covered; however, customer cost-share applies as of January 1, 2022. Insurance Reimbursement Rates for Psychotherapy, Insurance Reimbursement Rates for Psychiatrists, Beginners Guide To Mental Health Billing, https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf, guide on HIPAA compliant video technology for telehealth, https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf, Inquire about our mental health insurance billing service, offload your mental health insurance billing, We charge a percentage of the allowed amount per paid claim (only paid claims). Share sensitive information only on official, secure websites. It's convenient, not costly. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. Providers should bill the pre-admission or pre-surgical testing of COVID-19 separately from the surgery itself using ICD-10 code Z01.812 in the primary position. lock We maintain all current medical necessity review criteria for virtual care at this time. 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. Yes. 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. Emergent transport to nearby facilities capable of treating customers is covered without prior authorization. Modifier CR and condition code DR can also be billed instead of CS. 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 Modifier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): . These include: Virtual preventive care, routine care, and specialist referrals. HIPAA requirements apply to video telehealth sessions so please refer to our guide on HIPAA compliant video technology for telehealth to ensure youre meeting the requirements. Yes. You want to get paid quickly, in full, and not have to do more than spend 10 or 15 minutes to input your weekly calendar. 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. POS 11, 19 and 22) modifier GT or 95 (or GQ for Medicaid) must be used. A facility which primarily provides health-related care and services above the level of custodial care to individuals but does not provide the level of care or treatment available in a hospital or SNF. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. No additional modifiers are necessary to include on the claim. When a state allows an emergent temporary provider licensure, Cigna will allow providers to practice in that state as participating if a provider is already participating with Cigna, is in "good standing," and if state regulations allow such care to take place. 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. Before sharing sensitive information, make sure youre on a federal government site. Yes. On January 1, 2021, we implemented a Virtual Care Reimbursement Policy that ensures permanent coverage of certain virtual care services. Recent guidelines have recommended keeping the normal service facility that you are registered under in your CMS-1500. Comprehensive Inpatient Rehabilitation Facility. 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. 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. Yes. A provider should bill on the same form they usually do (e.g., CMS 1500 or UB-04) as when they provide the service face-to-face. Services include physical therapy, occupational therapy, and speech pathology services. Yes. new codes. 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. Therefore, as of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. 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.