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A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. When billing for telehealth, it's unclear what place of service code to use. all continue to be appropriate to use at this time. Activate your myCigna account nowto get access to a virtual dentist. If a provider administers a quick uniform screening (questionnaire) that does not result in a full evaluation and management service of any level, and then performs a COVID-19 test OR a collection service, they should bill only the laboratory code OR collection code. Effective January 1, 2021, we implemented a new. Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. The Center for Medicare and Medicaid Services (CMS) has announced that there is to be a change in the telehealth place of service (POS) code for billing Medicare and Medicaid Services. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. Reimbursement will be consistent as though they performed the service in a face-to-face setting. It's convenient, not costly. Billing an evaluation and management (E/M) code when that level of service is not provided is fraudulent billing and is expressly prohibited. Per usual policy, Cigna does not require three days of inpatient care prior to transfer to a SNF. There may be limited exclusions based on the diagnoses submitted. Beginning January 15, 2022, and through at least the end of the PHE (. . 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. 4. 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. Cigna will reimburse providers the full allowed amount of the claim, including what would have been the customer's cost share. These resources offer access to live-guided relaxation sessions, wellness podcasts, and wellness and stress management flyers. The COVID-19 billing and reimbursement guidelines that follow are for commercial Cigna medical services, including IFP, unless otherwise noted. M misstigris Networker Messages 63 Location Portland, OR We are committed to helping providers deliver care how, when, and where it best meets the needs of their patients. "All Rights Reserved." This website and its contents may not be reproduced in whole or in part without . Cigna Telehealth Place of Service Code: 02 Cigna Telehealth CPT Code Modifier: 95 We charge a percentage of the allowed amount per paid claim (only paid claims) No per claim submission fee No annual or monthly subscription fee A facility other than a hospital, which provides dialysis treatment, maintenance, and/or training to patients or caregivers on an ambulatory or home-care basis. 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. When administered consistently with Cigna's Drug and Biologics policy and EUA usage guidelines, Cigna will reimburse the infusion and post-administration monitoring of the listed treatments at contracted rates when specific contracted rates are in place for COVID-19 services. When 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). Listed below are place of service codes and descriptions. Providers that administer vaccinations to patients without health insurance or whose insurance does not provide coverage of vaccination administration fees, may be able to file a claim with the provider relief fund, but may not charge patients directly for any vaccine administration costs. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. 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. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Telehealth Provided Other than in Patients Home, Process for Requesting New Codes or Modification of Existing Codes, Place of Service Codes for Professional Claims (PDF), A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to American Indians and Alaska Natives who do not require hospitalization. Is Face Time allowed? Total 0 Results. Patient is not located in their home when receiving health services or health related services through telecommunication technology. Store and forward communications (e.g., email or fax communications) are not reimbursable. 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. Refer to the Telemedicine Website for a list of billing codes which may be used with Place of Service (POS) 02 or 10. In order to bill these codes, the test must be FDA approved or cleared or have received Emergency Use Authorization (EUA). Yes. 2. Separate codes providers may use to bill for supplies are generally considered incidental to the overall primary service and are not reimbursed separately. TheraThink.com 2023. Learn about the medical, dental, pharmacy, behavioral, and voluntary benefits your employer may offer. Cigna will also administer the waiver for self-insured group health plans and the company encourages widespread participation, although these plans will have an opportunity to opt-out of the waiver option or opt-in to extend the waiver past February 15, 2021. 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. When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance. https:// Billing for telehealth nutrition services may vary based on the insurance provider. Please review the Virtual care services frequently asked questions section on this page for more information. (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. 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 . Cigna may not control the content or links of non-Cigna websites. For dates of service February 4, 2020 through February 15, 2021, Cigna covered COVID-19 treatments without customer cost-share. No. As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. No. Because we believe virtual care has the potential to help you attract and retain patients, reduce access barriers, and contribute to your ability to provide the right care at the right time, we wanted to implement a policy that ensures you can continue to receive ongoing reimbursement for virtual care that you deliver to your patients with Cigna commercial medical coverage. that insure or administer group HMO, dental HMO, and other products or services in your state). As of July 1, 2022, standard credentialing timelines again apply. The Department may not cite, use, or rely on any guidance that is not posted Live-guided relaxation by telephone Available for all providers at no cost Every Tuesday at 5:00pm ET Call 866.205.5379, enter passcode 113 29 178, and then press # Additional Resources Cigna Medicare Billing guidelines and telehealth Cigna Dental Interim Communication to Providers QualCare Workers Compensation Interim billing guidance Most mental health providers will be furnishing services using Place of Service code 10 (POS 10) when providing telehealth services. (As of 10/14/2020) Where can providers access the telemedicine policy and related codes? Claims were not denied due to lack of referrals for these services during that time. Cigna covers C9803 with no customer cost-share for a hospital outpatient clinic visit specimen collection, including drive-thru tests, through at least May 11, 2023 only when billed without any other codes. Listed below are place of service codes and descriptions. Yes. You get connected quickly. No. 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. As always, we remain committed to ensuring that: Yes. Yes. UnitedHealthcare (UHC) is now requiring physicians to bill eligible telehealth services with place of service (POS) 02 for commercial products. If antibodies are present, it means that individual previously had a specific viral or bacterial infection - like COVID-19. 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. If you are looking for more comprehensive implementation . Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. Please review the Virtual Care Reimbursement Policy for additional details on the added codes. Therefore, please refer to those guidelines for services rendered prior to January 1, 2021. Under normal circumstances, the provider would bill with the Place of Service code 2, to indicate the care was rendered via telehealth. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). Update to the telehealth Place of Service (POS) code Telehealth continues to be an integral part of providing safe and convenient health care visits for Medicare Advantage beneficiaries. 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). As of April 1, 2021, Cigna resumed standard authorization requirements. This guidance applies to all providers, including laboratories. mitchellde True Blue Messages 13,505 Location Columbia, MO Best answers 2 Mar 9, 2020 #2 Those are the codes for a phone visit. 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). In compliance with federal agency guidance, however, Cigna covers individualized COVID-19 diagnostic tests without cost-share through at least May 11, 2023 for asymptomatic individuals when referred by or administered by a health care provider. Cigna 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. Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. Effective for dates of service on and after March 2, 2020 until further notice, Cigna will cover eConsults when billed with codes 99446-99449, 99451 and 99452 for all conditions. Audio -only CPT codes 98966 98968 and 99441 DISCLAIMER: The contents of this database lack the force and effect of law, except as Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF). This includes: Please refer to the interim COVID-19 virtual care guidelines for a complete outline of our interim COVID-19 virtual care coverage. Yes. 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. Customer cost-share will be waived for COVID-19 related virtual care services through at least. Ultimately however, care must be medically necessary to be covered. Providers can bill code G2012 for a quick 5-10 minute phone conversation as part of our R31 Virtual Care Reimbursement Policy, with cost-share waived through at least May 11, 2023 for customers when the conversation is related to COVID-19. Please note that we continue to request that providers do not bill with modifiers 93 or FQ at this time. 1 In an emergency, always dial 911 or visit the nearest hospital. While the R31 Virtual Care Reimbursement Policy that went into effect on January 1, 2021 only applies to claims submitted on a CMS-1500 claim form, we will continue to reimburse virtual care services billed on a UB-04 claim form until further notice when the services: Please note that existing reimbursement policies will apply and may affect claims payment (e.g., R30 E&M Services). Providers receive reasonable reimbursement consistent with national CMS rates for administering EUA-approved COVID-19 vaccines. 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. We maintain all current medical necessity review criteria for virtual care at this time. INTERIM TELEHEALTH GUIDANCE Announcement from Cigna Behavioral Health . Youll receive a summary of your screening results for your records. Please review the Virtual care services frequently asked questions section on this page for more information. Yes. Yes. We will also continue to consider Centers for Medicare & Medicaid (CMS) guidance, industry standards, and affordability for our clients to help inform any potential future changes to our reimbursement approach. We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information. A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. Non-residential Substance Abuse Treatment Facility, Non-residential Opioid Treatment Facility, A location that provides treatment for opioid use disorder on an ambulatory basis. When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9. Phone, video, FaceTime, Skype, Zoom, etc. R33 COVID-19 Interim Billing Guidelines policy, COVID-19: In Vitro Diagnostic Testing coverage policy, COVID-19 In Vitro Diagnostic Testing coverage policy, Express Scripts discount prescription program, Centers for Medicare & Medicaid Services (CMS) COVID-19 vaccine resources, Cigna Coronavirus (COVID-19) Resource Center, 0001A, 0002A, 0003A, 0004A, 0011A, 0012A, 0013A, 0031A, 0034A, 0041A, 0042A, 0044A, 0051A, 0052A, 0053A, 0054A, 0064A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A, 0124A, 0134A, 0144A, 0154A, 0164A, 0173A, and M0201, Virtual screening telephone consult (5-10 minutes), Virtual or face-to-face visit for treatment of a, Drug and administration of infusion treatments for a confirmed COVID-19 case, M0220, M0221, M0222, M0223, M0240, M0241, M0243, M0244, M0245, M0246, M0247, M0248, M0249, Q0222, and M0250, COVID-19 laboratory testing (including PCR, antigen, and serology [i.e., antibody] tests), COVID-19 related diagnostic tests (other than COVID-19 test), Non COVID-19 virtual visit (i.e., telehealth), In-office or facility visit not related to COVID-19, Pfizer-BioNTech COVID-19 Vaccine Administration First Dose, Pfizer-BioNTech COVID-19 Vaccine Administration Second Dose, Pfizer-BioNTech COVID-19 Vaccine Administration Third Dose, Pfizer-BioNTech COVID-19 Vaccine Administration Booster, Moderna COVID-19 Vaccine Administration First Dose, Moderna COVID-19 Vaccine Administration Second Dose, Moderna COVID-19 Vaccine Administration Third Dose, Janssen COVID-19 Vaccine Administration Booster, Novavax COVID-19 Vaccine, Adjuvanted Administration First Dose, Novavax COVID-19 Vaccine, Adjuvanted Administration Second Dose, Novavax COVID-19 Vaccine, Adjuvanted Administration Booster, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - First dose, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Second dose, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Third dose, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Booster, Moderna COVID-19 Vaccine (Low Dose) Administration Booster, Pfizer-BioNTech COVID-19 Pediatric Vaccine Administration First dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine Administration Second dose, Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration Third dose, Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration Booster, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration First dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration Second dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration Third dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration First dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration Second dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration Third dose, Moderna COVID-19 Vaccine (Blue Cap) 50MCG/0.5ML Administration Booster, Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration First dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration Second dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration Third dose, Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Gray Cap) Administration Booster Dose, Moderna COVID-19 Vaccine, Bivalent (Aged 18 years and older) (Dark Blue Cap with gray border) Administration Booster Dose, Moderna COVID-19 Vaccine, Bivalent (Aged 6 years through 11 years) (Dark Blue Cap with gray border) Administration Booster Dose, Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 5 years through 11 years) (Orange Cap) Administration Booster Dose, Moderna COVID-19 Vaccine, Bivalent (Aged 6 months through 5 years) (Dark Pink Cap and label with a yellow box) Administration Booster Dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration Third dose, The initial COVID-19 diagnostic service (virtually, in an office, or at an emergency room, urgent care center, drive thru specimen collection center, or other facility), Specimen collection by a health care provider, Laboratory test (performed by state, hospital, or commercial laboratory; or other provider), Treatment (treatments that Cigna will cover for COVID-19 are those covered under Medicare or other applicable state regulations). When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. 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). The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. 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. This will help with tracking purposes, and ensure timely reimbursement for the administration of the treatment. We also continue to make several additional accommodations related to virtual care until further notice. POS 11, 19 and 22) modifier GT or 95 (or GQ for Medicaid) must be used. To this end, we will use all feedback we receive to consider further updates to our policy. While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. 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. 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. It must be initiated by the patient and not a prior scheduled visit. If an urgent care center performs an evaluation and treatment service, collects a specimen for COVID-19, and runs the laboratory test, they should bill just their per-visit S9083 code or just the laboratory code. eConsult services remain covered; however, customer cost-share applies as of January 1, 2022. For more information, see the resources along the right-hand side of the screen. a listing of the legal entities It remains expected that the service billed is reasonable to be provided in a virtual setting. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. Please visit CignaforHCP.com/virtualcare for additional information about that policy. The .gov means its official. No. In such cases, we will review the services provided on appeal for medical necessity to determine appropriate coverage.As a reminder, precertification is not required for the evaluation, testing, or medically necessary treatment of Cigna customers related to COVID-19. 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. Talk privately with a licensed therapist or psychiatrist by appointment using your phone, tablet, or computer. Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; Note that billing B97.29 will not waive cost-share. The facility that the patient is being transferred to (e.g., SNF, AR, or LTACH) is responsible for notifying Cigna of admissions the next business day. Yes. Cigna does not provide additional reimbursement for PPE-related costs, including supplies, materials, and additional staff time (e.g., CPT codes 99072 and S8301), as office visit (E&M) codes include overhead expenses, such as necessary PPE. POS codes are two-digit codes reported on . Our newest Playbook in the series focuses on the implementation of telehealth (PDF), defined as real-time, audio-visual visits between a clinician and patient. 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.