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. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing. Modifier 95, GT, or GQ must be appended to the virtual care code(s). When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. Yes. BCBSNC Telehealth Corporate Reimbursement Policy CIGNA Humana Humana Telehealth Expansion 03/23/2020 Humana provider FAQs Medicaid Special Bulletin #28 03/30/2020 (Supersedes Special Bulletin #9) Medicare Telemedicine Provider Fact Sheet 03/17/2020 Medicare Waivers 03.30.2020 PalmettoGBA MLN Connects Special Edition - Tuesday, March 31, 2020 Providers should bill this code for dates of service on or after December 23, 2021. UnitedHealthcare (UHC) is now requiring physicians to bill eligible telehealth services with place of service (POS) 02 for commercial products. Providers that receive the COVID-19 vaccine free of charge from the federal government are prohibited from seeking reimbursement from consumers for vaccine administration costs whether as cost sharing or balance billing. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. Listed below are place of service codes and descriptions. When specific contracted rates are in place for diagnostic COVID-19 tests, Cigna will reimburse covered services at those contracted rates. 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. I cannot capture in words the value to me of TheraThink. End-Stage Renal Disease Treatment Facility. Cigna allows modifiers GQ, GT, or 95 to indicate virtual care for all services. eConsult services remain covered; however, customer cost-share applies as of January 1, 2022. While as part of this policy, Urgent Care centers billing virtual care on a global S code is not reimbursable, we do continue to reimburse these services until further notice as part of our interim COVID-19 guidelines. * POS code 10 POS code name For the purposes of private practice, the three most common service codes therapists are likely to bill are "11" (office), "12" (in-home services), and "2" (telehealth). Cigna will determine coverage for each test based on the specific code(s) the provider bills. Service codes Physicians: use service codes 99441-99443; Non-physicians: use 98966-98968 We're waiving copays for telehealth visits for behavioral and mental health counseling for members eligible for managed long-term services and supports (MLTSS) and Division of Developmental . A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients. When specific contracted rates are in place for COVID-19 specimen collection services, Cigna will reimburse covered services at those contracted rates. Anthem would recognize IOP services that are rendered via telehealth with a revenue code (905, 906, 912, 913), plus CPT codes for specific behavioral health services. 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. For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. Yes. Obtain your Member Code with just HK$100. Customers will be referred to seek in-person care. 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. Yes. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 Please visit. Congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services. 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.). POS 02: Telehealth Provided Other than in Patient's Home Schedule an appointment online with MDLIVE and visit a lab for your blood work and biometrics. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. Yes. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. Contracted providers cannot balance bill customers for non-reimbursable codes. 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. No additional modifiers are necessary to include on the claim. 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 hope you join us in our journey to offer our customers increased access to virtual care and appreciate your commitment to work with us as our virtual care platform continues to evolve to the meet the needs of our providers, customers, and clients. In certain cases, yes. 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). Telehealth claims with any other POS will not be considered eligible for reimbursement. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. Urgent care centers can bill their global S code when a significant and separately identifiable service is performed at the same time as the administration of the vaccine, but will only be reimbursed for both services when their contract allows it (similar to how they may be reimbursed today for flu shot administration). 24/7, live and on-demand for a variety of minor health care questions and concerns. Cigna does not generally cover tests for asymptomatic individuals when the tests are performed for general public health surveillance, for employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19. Previously, these codes were reimbursable as part of our interim COVID-19 accommodations. POS 10 Telehealth provided in a patient's home was created for services provided remotely to a patient in their private residence. No. Please note that our interim COVID-19 virtual care guidelines were in place until December 31, 2020. a listing of the legal entities 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. 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 Cigna covers diagnostic antibody tests when the results of the antibody test will be used to aid in the diagnosis of a condition related to COVID-19 antibodies (e.g., Multisystem Inflammatory Syndrome). 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. All Time (0 Recipes) Past 24 Hours Past Week Past month. Primary care physician referrals for specialist office visits were temporarily waived for Individual & Family Plans (IFP) in Illinois and for all SureFit plans through May 31, 2021. Recent guidelines have recommended keeping the normal service facility that you are registered under in your CMS-1500. ICD-10 code U07.1, J12.82, M35.81, or M35.89. If you are looking for more comprehensive implementation . Please review our R33 COVID-19 Interim Billing Guidelines policy for ICD-10 diagnosis code requirements to have cost-share waived for G2012. Yes. 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. As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. Services may be rendered via telemedicine when the service is: A covered Health First Colorado benefit, Within the scope and training of an enrolled provider's license, and; Appropriate to be rendered via telemedicine. Similarly, if a cardiologist is brought in to consult in a face-to-face setting within a facility setting, that cardiologist can also provide services virtually billing a face-to-face evaluation and management (E&M) visit (the same code[s] on their fee schedule and the same claim form [e.g., CMS 1500 or UB-04]). Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis. Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. Throughout the pandemic, the emergency use authorized monoclonal antibody drug bebtelovimab was purchased by the federal government and offered to providers for free. For telephone services only, codes are time based. that insure or administer group HMO, dental HMO, and other products or services in your state). We will also closely monitor and audit claims for inappropriate services that should not be performed virtually (including but not limited to: acupuncture, all surgical codes, anesthesia, radiology services, laboratory testing, administration of drugs and biologics, infusions or vaccines, and EEG or EKG testing). Yes. Modifier CR and condition code DR can also be billed instead of CS. Antibody tests: 86328, 86769, 86408, 86409, 86413, and 0224U, Cigna covers diagnostic molecular and antigen tests for COVID-19 through at least. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. As always, we remain committed to ensuring that: Yes. A medical facility operated by one or more of the Uniformed Services. Urgent care centers will not be reimbursed separately when they bill for multiple services. We maintain all current medical necessity review criteria for virtual care at this time. 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. The .gov means its official. A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. If specimen collection and a laboratory test are billed together, only the laboratory test will be reimbursed. Billing an evaluation and management (E/M) code when that level of service is not provided is fraudulent billing and is expressly prohibited. As of July 1, 2022, we request that providers bill with POS 02 for all virtual care. The 02 Place of Service code will automatically populate onto your courtesy claims and Superbills when the appointment is scheduled at that location. Cigna Telehealth Place of Service Code: 02. 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. What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? In addition, the discharging provider or primary care physician can provide the post discharge visit virtually if appropriate. Precertification (i.e., prior authorization) requirements remain in place. 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. (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. This guidance applies to all providers, including laboratories. Hospitals are still required to make their best efforts to notify Cigna of hospital admissions in part to assist with discharge planning. Please visit. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. (Description change effective January 1, 2016). 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 . Summary of Codes for Use During State of Emergency. Emergent transport to nearby facilities capable of treating customers is covered without prior authorization. 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. On July 2, 2021 MVP announced changes to member cost-share effective August 1, 2021. This will help us to meet customers' clinical needs and support safe discharge planning. Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. 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. 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 monitor for any updates from the administration and are evaluating potential changes to our ongoing COVID-19 accommodations as a result of the PHE ending. 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. It's our goal to ensure you simply don't have to spend unncessary time on your billing. 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. (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.). Providers who are administering the COVID-19 vaccine in a site other than their typical office or facility setting (e.g., at a sports complex) can bill us under their regular facility location. 1 A facility, other than a patient's home, in which palliative and supportive care for terminally ill patients and their families are provided. ) 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. 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. Cigna will not make any limitation as to the place of service where an eConsult can be used.