3 Biometric screening experience may vary by lab. Generally, only well-equipped commercial laboratories and hospital-based laboratories will have the necessary equipment to offer these tests. 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. Yes. 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. When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance. For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. These resources offer access to live-guided relaxation sessions, wellness podcasts, and wellness and stress management flyers. No. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. Washington, D.C. 20201 For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. To speak with a dentist,log in to myCigna. Claims were not denied due to lack of referrals for these services during that time. Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. Telehealth services not billed with 02 will be denied by the payer. 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. Providers should bill the relevant vaccine administration code (e.g., 0001A, 0002A, etc.) Federal government websites often end in .gov or .mil. 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. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. 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. 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. Yes. 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. Residential Substance Abuse Treatment Facility. For providers whose contracts utilize a different reimbursement We also continue to make several other accommodations related to virtual care until further notice. (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.). Providers should append the GQ, GT, or 95 modifier and Cigna will reimburse them consistent with their face-to-face rates. Store and forward communications (e.g., email or fax communications) are not reimbursable. Yes. Beginning January 15, 2022, and through at least the end of the PHE (. As of January 1, 2022, a new POS code has been approved to report more specifically where services were provided. Effective with January 1, 2021 dates of service, we implemented a new Virtual Care Reimbursement Policy. 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. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. M0222 (administration in facility setting): $350.50, M0223 (administration in home setting): $550.50. 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. New telehealth POS A new place of service (POS) code will go into effect Jan. 1, 2022, but Medicare doesn't plan on using it. 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. Please review our R33 COVID-19 Interim Billing Guidelines policy for ICD-10 diagnosis code requirements to have cost-share waived for G2012. While the policy - announced in United's . Modifier 95, indicating that you provided the service via telehealth. 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. Cigna will not reimburse providers for the cost of the vaccine itself. Emotional health resources have been added to the COVID-19 interim guidance page for behavioral providers at CignaforHCP.com. Usually not. Know how to bill a facility fee Place of Service 02 in Field 24-B (see sample claim form below) For illustrative purposes only. When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). POS 02: Telehealth Provided Other than in Patient's Home Telephone, Internet, or electronic health record consultations of less than five minutes should not be billed. Other place of service not identified above. 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. 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. Cigna will reimburse at 100% of face-to-face rates, even when billing POS 02. Learn about the medical, dental, pharmacy, behavioral, and voluntary benefits your employer may offer. Reimbursement, when no specific contracted rates are in place, are as follows: No. All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02. While Cigna doesn't require further credentialing or license validation, and the provider can work under the scope of their license, providers are encouraged to inform Cigna when they will practice across state lines. 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. were all appropriate to use). Note that billing B97.29 will not waive cost-share. lock Modifier CR and condition code DR can also be billed instead of CS. Official websites use .govA You get connected quickly. 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. On January 1, 2021, we implemented a Virtual Care Reimbursement Policy that ensures permanent coverage of certain virtual care services. Yes. 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 listing of the legal entities 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. No. 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. Yes, the cost-share waiver for COVID-19 treatment ended on February 15, 2021. 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. Let us handle handle your insurance billing so you can focus on your practice. What place of service code should be used for telemedicine services? This will help us to meet customers' clinical needs and support safe discharge planning. If an urgent care center 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. 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 Place of Service Code Set. As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. As of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. (This code is available for use immediately with a final effective date of May 1, 2010), A location, not described by any other POS code, owned or operated by a public or private entity where the patient is employed, and where a health professional provides on-going or episodic occupational medical, therapeutic or rehabilitative services to the individual. Yes. 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. My cost is a percentage of what is insurance-approved and its my favorite bill to pay each month! For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. In these cases, the non-credentialed provider can bill under the group assuming they are practicing within state laws to administer the vaccine. Services performed on and after March 1, 2023 would have just their standard timely filing window. 3. 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. Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). 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. 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. 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). We are awaiting further billing instructions for providers, as applicable, from CMS. Throughout the pandemic, the emergency use authorized monoclonal antibody drug bebtelovimab was purchased by the federal government and offered to providers for free. Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place at least until the end of Public Health Emergency (PHE) period. Place of Service 02 will reimburse at traditional telehealth rates. Yes. 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. Modifier CR or condition code DR can also be billed instead of CS. Providers should bill this code for dates of service on or after December 23, 2021. Please note that cost-share still applies for all non-COVID-19 related services. all continue to be appropriate to use at this time. Providers will continue to be reimbursed at 100% of their face-to-face rates for covered virtual care services, even when billing POS 02. This code will only be covered where state mandates require it. 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. It's our goal to ensure you simply don't have to spend unncessary time on your billing. Most mental health providers will be furnishing services using Place of Service code 10 (POS 10) when providing telehealth services. Standard customer cost-share applies. (Effective January 1, 2003). 5 Virtual dermatological visits through MDLIVE are completed via asynchronous messaging. 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. 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. 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 example, if a dietician or occupational therapist would typically see a patient in an outpatient setting, but that service is now provided virtually, that dietician or occupational therapist would bill the same way they do for that face-to-face visit using the existing codes on their fee schedule and existing claim form they typically bill with (e.g., CMS 1500 or UB-04) and append the GQ, GT, or 95 modifier. Additional FDA EUA approved vaccines will be covered consistent with this guidance. Please note that this guidance applies to drive through testing as well, and includes services performed by a free-standing emergency room or any other provider. Cigna covers FDA EUA-approved laboratory tests. Precertification (i.e., prior authorization) requirements remain in place. Below is a definition of POS 02 and POS 10 for CMS-1500 forms, alongside a list of major insurance brands and their changes. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Listed below are place of service codes and descriptions. Coverage reviews for appropriate levels of care and medical necessity will still apply. Providers should bill one of the above codes, along with: No. 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. Yes. https:// Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. Clarifying Codes G0463 and Q3014 Unfortunately, this policy also created a great deal of confusion and inconsistency among providers regarding which code to bill when providing remote clinic visits: G0463, Hospital outpatient clinic visit for assessment and management of a patient, or Q3014, Telehealth originating site facility fee. Please visit CignaforHCP.com/virtualcare for additional information about that policy. In these cases, providers should bill their regular face-to-face codes that are on their fee schedule, and add the GQ, GT, or 95 modifier to indicate the services were performed virtually. Every provider we work with is assigned an admin as a point of contact. An official website of the United States government The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). Last updated February 15, 2023 - Highlighted text indicates updates. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. 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. Providers will not need a specific consent from patients to conduct eConsults. 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. When billing for the service, indicate the place of service as where the visit would have occurred if in person. Is Face Time allowed? 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. Please note that HMO and other network referrals remained required through the pandemic, so providers should have continued to follow the normal process that has been in place. As of July 1, 2022, we request that providers bill with POS 02 for all virtual care. Area (s) of Interest: Payor Issues and Reimbursement. A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services rendered by, or under the supervision of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients. ICD-10 code U07.1, J12.82, M35.81, or M35.89. Also consistent with CMS, we will reimburse providers an additional $25 when they return the result of the test to the patient within two days and bill Cigna code U0005. When specific contracted rates are in place for COVID-19 vaccine administration services, Cigna will reimburse covered services at those contracted rates. (Description change effective January 1, 2016). Cigna does require prior authorization for fixed wing air ambulance transport. For all other IFP plans outside of Illinois, primary care physicians are still encouraged to coordinate care and assist in locating in-network specialists, but the plans no longer have referral requirements as of January 1, 2021. For telehealth, the 95 modifier code is used as well. Cigna waived cost-share for COVID-19 related treatment, in both inpatient and outpatient settings, through February 15, 2021 dates of service. 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]). Claims must be submitted on a CMS-1500 form or electronic equivalent. For telephone services only, codes are time based. DISCLAIMER: The contents of this database lack the force and effect of law, except as Listed below are place of service codes and descriptions. Yes. The Department may not cite, use, or rely on any guidance that is not posted Reimbursement for the administration of the injection will remain the same. A medical facility operated by one or more of the Uniformed Services. Location, other than a hospital or other facility, where the patient receives care in a private residence. Providers should bill with POS 02 for all virtual care claims, as we updated our claims systems to ensure providers receive 100 percent of face-to-face reimbursement for covered virtual care when using POS 02. Please review the Virtual care services frequently asked questions section on this page for more information. What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? No. 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. Certain PT, OT, and ST virtual care services remain reimbursable under the R31 Virtual Care Reimbursement Policy. No. No virtual care modifier is needed given that the code defines the service as an eConsult. 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. We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. Please note that state mandates and customer benefit plans may supersede our guidelines. Cigna Telehealth Place of Service Code: 02. If the telephone, Internet, or electronic health record consultation leads to a transfer of care or other face-to-face service (e.g., a surgery, a hospital visit, or a scheduled office evaluation of the patient) within the next 14 days or next available appointment date of the consultant, these codes should not be billed.