new codes. . 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. 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 virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02. Thanks for your help! Diluents are not separately reimbursable in addition to the administration code for the infusion. When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance. Unlisted, unspecified and nonspecific codes should be avoided. Area (s) of Interest: Payor Issues and Reimbursement. Cigna will 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, EEG or EKG testing). It's convenient, not costly. All health insurance policies and health benefit plans contain exclusions and limitations. 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. Is Face Time allowed? When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. Diagnoses requiring testing cannot be confirmed. (Effective January 1, 2016). Therefore, as of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours. Yes. Please review the Virtual care services frequently asked questions section on this page for more information. We covered codes 99441-99443 as part of these interim COVID-19 guidelines, and continue to cover them as part of the R31 Virtual Care Reimbursement Policy. Cigna covers the administration of the COVID-19 vaccine with no customer cost-share (i.e., no deductible or co-pay) when delivered by any provider or pharmacy. 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. 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. Cigna covers pre-admission and pre-surgical COVID-19 testing with no customer cost-share when performed in an outpatient setting through at least May 11, 2023. (As of 10/14/2020) Where can providers access the telemedicine policy and related codes? Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually until further notice. Get non-narcotic prescriptions sent directly to your local pharmacy, if appropriate. Yes. Effective with January 1, 2021 dates of service, we implemented a new Virtual Care Reimbursement Policy. 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. (Receive an extra 25% off with payment made by Mastercard.) Place of Service (POS) equal to what it would have been had the service been provided in-person. 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. Total 0 Results. Please review the "Virtual care services" frequently asked questions section on this page for more information. A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients. If the patient is in their home, use "10". 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. POS 11, 19 and 22) modifier GT or 95 (or GQ for Medicaid) must be used. 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. When providers purchase the drug itself from the manufacturer (e.g., bebtelovimab billed with Q0222), Cigna will reimburse the cost of the drug when covered. There may be limited exclusions based on the diagnoses submitted. This is a key difference between Commercial and Medicare risk . Location, distinct from a hospital emergency room, an office, or a clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention. (99441, 98966, 99442, 98967, 99334, 98968). The covered procedure codes for E-visits/online portal services include: 99421, 99422, 99423, G2061, G2062, G2063. When billing telehealth services, healthcare providers must bill the E&M code with place of service code 02 along with a GT or 95 modifier. Services performed on and after March 1, 2023 would have just their standard timely filing window. Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. Listed below are place of service codes and descriptions. 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. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. POS codes are two-digit codes reported on . What place of service code should be used for telemedicine services? 3. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 A location which provides treatment for substance (alcohol and drug) abuse on an ambulatory basis. Yes. 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. Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. 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. 3. Please note that our interim COVID-19 virtual care guidelines were in place until December 31, 2020. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. 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. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. No waiting rooms. Patient is not located in their home when receiving health services or health related services through telecommunication technology. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. Yes. 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). Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders. Usually not. For providers whose contracts utilize a different reimbursement 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. 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. Telehealth services not billed with 02 will be denied by the payer. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. a listing of the legal entities In 2017, Cigna launched behavioral telehealth sessions for all their members. ), but the patient is also tested for COVID-19 for diagnostic reasons, the provider should bill the diagnosis code specific to the primary reason for the encounter in the first position, and the COVID-19 diagnosis code in any position after the first. 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. Yes. 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. The accelerated credentialing accommodation ended on June 30, 2022. Cigna understands the tremendous pressure our healthcare delivery systems are under. The .gov means its official. When no specific contracted rates are in place, providers will be reimbursed $40 per dose for general vaccine administration and an additional $35.50 per dose for administering it in a home setting for total reimbursement of $75.50 per vaccine dose. 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. All Cigna pharmacy and medical plans will cover Paxlovid and molnupiravir at any pharmacy or doctors office (in- or out-of-network) that has them available. New/Modifications to the Place of Service (POS) Codes for Telehealth. Comprehensive Inpatient Rehabilitation Facility. Cost-share will be waived only when providers bill the appropriate ICD-10 code (U07.1, J12.82, M35.81, or M35.89). It remains expected that the service billed is reasonable to be provided in a virtual setting. *Please Note: virtual check-in and E-visit codes must be billed with Place of Service (POS) 02 and modifier GT. You get connected quickly. lock 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. Please note that this list is not all inclusive and may not represent an exact indication match. Cigna will reimburse providers the full allowed amount of the claim, including what would have been the customer's cost share. PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. 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. Place of Service Code Set. We also continue to make several other accommodations related to virtual care until further notice. Let us handle handle your insurance billing so you can focus on your practice. The ordering provider should use the standard, existing process to submit home health orders to eviCore healthcare. 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. Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. More information about coronavirus waivers and flexibilities is available on . identify telehealth or telephone (audio only) services that were historically performed in the office or other in person setting (E.g. When billing for the service, indicate the place of service as where the visit would have occurred if in person. Yes. Customer cost-share will be waived for COVID-19 related virtual care services through at least. 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. Modifier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): . Claims must be submitted on a CMS-1500 form or electronic equivalent. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). On-demand virtual care for minor medical conditions, Talk therapy and psychiatry from the privacyof home. Yes. Prior authorization is not required for COVID-19 testing. Through February 15, 2021, Cigna waived customer cost-share for any approved COVID-19 treatment, no matter the location of the service. Note that high-throughput tests may only be run in a high-complexity laboratory; The laboratory or provider bills using the codes in our interim billing guidelines and. MLN Matters article MM12549, CY2022 telehealth update Medicare physician fee schedule. 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. Yes. 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. In these cases, the provider should bill as normal on a UB-04 claim form with the appropriate revenue code and procedure code, and also append the GQ, GT, or 95 modifier. Therefore, to increase convenient 24/7 access to care if a customers preferred provider is unavailable in-person or virtually, covered virtual care is also available through national virtual care vendors like MDLive. Free Account Setup - we input your data at signup. 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. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). Recent guidelines have recommended keeping the normal service facility that you are registered under in your CMS-1500. 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. Concurrent review will start the next business day with no retrospective denials. It's our goal to ensure you simply don't have to spend unncessary time on your billing. For telephone services only, codes are time based. My cost is a percentage of what is insurance-approved and its my favorite bill to pay each month! 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. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. 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. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. 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. 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. Other place of service not identified above. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. We continue to make several other accommodations related to virtual care until further notice. In addition, Anthem would recognize telephonic-only . 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, Urgent care centers to offer virtual care when billing with a global S9083 code, Most synchronous technology to be used (e.g., FaceTime, Skype, Zoom, etc. We also continue to work directly with providers to understand the financial implications that virtual care reimbursement may have on practices. 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 For telehealth, the 95 modifier code is used as well. The interim COVID-19 virtual care guidelines as outlined on this page were in place for dates of service through December 31, 2020. All other customers will have the same cost-share as if they received the services in-person from that same provider. (As of 01/21/2021) What Common Procedural Technology (CPT) codes should be used for COVID-19 testing? 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. 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. Please note that customer cost-share and out-of-pocket costs may vary for services customers receive through our virtual care vendor network (e.g., MDLive). 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. Listed below are place of service codes and descriptions. Approximately 98% of reviews are completed within two business days of submission. 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.

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