1995-2020 by the American Academy of Orthopaedic Surgeons. The 02 Place of Service code will automatically populate onto your courtesy claims and Superbills when the appointment is scheduled at that location. Outpatient E&M codes for new and established patients (99202-99215) Physical and occupational therapy E&M codes (97161-97168) Telephone-only E&M codes (99441-99443) Annual wellness visit codes (G0438 and G0439) For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. 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. You want to know you can call your billing admin, a real person you've already spoken with, and get immediate answers about your claims. In these cases, the urgent care center should append a GQ, GT, or 95 modifier, and we will reimburse the full face-to-face rate for insured and Non-ERISA ASO customers in states where telehealth parity laws exist. Yes. 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 (whether billed on the same or different claims). A facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program for patients who do not require full time hospitalization, but who need broader programs than are possible from outpatient visits to a hospital-based or hospital-affiliated facility. 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. codes and normal billing procedures. Talk directly to board-certified providers 24/7 by video or phone for help with minor, non-life-threatening medical conditions1. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. In order to bill these codes, the test must be FDA approved or cleared or have received Emergency Use Authorization (EUA). 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. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Cigna commercial and Cigna Medicare Advantage customers receive the COVID-19 vaccine with no out-of-pocket costs; and. No virtual care modifier is needed given that the code defines the service as an eConsult. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. Cigna will allow direct emergent or urgent transfers from an acute inpatient facility to a second acute inpatient facility, skilled nursing facility (SNF), acute rehabilitation facility (AR), or long-term acute care hospital (LTACH). 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). The location where health services and health related services are provided or received, through telecommunication technology. It must be initiated by the patient and not a prior scheduled visit. 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. 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. 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. This generally takes place in a mass immunization setting, such as, a public health center, pharmacy, or mall but may include a physician office setting. POS 11, 19 and 22) modifier GT or 95 (or GQ for Medicaid) must be used. Organizations that offer Administrative Services Only (ASO) plans will be opted in to waiving cost-share for this service as well. 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. As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. 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. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. Ultimately however, care must be medically necessary to be covered. 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. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing. ** The Benefits of Virtual Care No waiting rooms. (Effective January 1, 2003). Yes. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. Denny has interviewed hundreds of mental health practitioners to better understand their struggles and solutions, all with the goal of making the professional side of behavioral health a little easier, faster, and less expensive. 3. 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. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). Before sharing sensitive information, make sure youre on a federal government site. Yes. . Standard customer cost-share applies. 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. 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. 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. all continue to be appropriate to use at this time. 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 As of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. The covered procedure codes for E-visits/online portal services include: 99421, 99422, 99423, G2061, G2062, G2063. 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. 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. Except for the telephone-only codes (99441-99443), all services must be interactive and use both audio and video internet-based technologies (synchronous communication) in order to be covered. For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. 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). As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. End-Stage Renal Disease Treatment Facility. No additional credentialing or notification to Cigna is required. We also continue to work directly with providers to understand the financial implications that virtual care reimbursement may have on practices. 1. No. 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. CMS officially has designated a Place of Service code for all of the telehealth to be "02" starting April 1, 2020. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. Details, Watch this short video to learn more about virtual care with MDLive. Yes. POS codes are two-digit codes reported on . A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician. This policy applied to customers in the United States who are covered under Cigna's employer/union sponsored insured group health plans, insured plans for US-based globally mobile individuals, Medicare Advantage, and Individual and Family Plans (IFP). Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. 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. HIPAA does not require patient consent for consultation and coordination of care with health care providers in the ordinary course of treatment for their patients. Psychiatric Facility-Partial Hospitalization. We also continue to make several additional accommodations related to virtual care until further notice. 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. Coverage reviews for appropriate levels of care and medical necessity will still apply. 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. To increase convenient 24/7 access to care if a patients preferred provider is unavailable in-person or virtually, our virtual care platform also offers solutions that include national virtual care vendors like MDLive. 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. 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. 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. Because health care providers are the most trusted source of information for consumers who are hesitant about receiving the vaccine, we continue to encourage providers to proactively educate their patients especially those who may have vaccine hesitancy or who are at high-risk of severe COVID-19 illness on the safety, effectiveness, and availability of the vaccine. 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. POS 02: Telehealth Provided Other than in Patient's Home List the address of the physician for the telehealth visit on the CMS1500 claim. Therefore, your patients with Cigna commercial coverage can purchase OTC tests from a health care provider and seek reimbursement by billing Cigna directly following our published guidance. Heres how you know. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; 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. Cigna covers FDA EUA-approved laboratory tests. This will help us to meet customers' clinical needs and support safe discharge planning. When specific contracted rates are in place for diagnostic COVID-19 lab tests, Cigna will reimburse covered services at those contracted rates. Talk to board-certified dermatologists without an appointment for customized care for skin, hair, and nail conditions. Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. We maintain all current medical necessity review criteria for virtual care at this time. *Please Note: virtual check-in and E-visit codes must be billed with Place of Service (POS) 02 and modifier GT. Add in the unnecessarily difficult insurance billing system and we run the risk of working way over full-time. A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician's office. Please review the Virtual Care Reimbursement Policy for additional details on the added codes. Other place of service not identified above. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. and the home vaccine administration code (M0201) on the same claim under the medical benefit.When specific contracted rates are in place for vaccine administration services, Cigna will reimburse covered services at those contracted rates. Yes. Unlisted, unspecified and nonspecific codes should be avoided. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. If you are rendering services as part of a facility (i.e., intensive outpatient program . Yes. 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. Primary care physician to specialist requesting input from a cardiologist, psychiatrist, pulmonologist, allergist, dermatologist, surgeon, oncologist, etc. 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. 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. When billing for telehealth, it's unclear what place of service code to use. Important notes, What the accepting facility should know and do. that insure or administer group HMO, dental HMO, and other products or services in your state). While the policy - announced in United's . 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. Yes. On-demand virtual care for minor medical conditions, Talk therapy and psychiatry from the privacyof home. Claims must be submitted on a CMS-1500 form or electronic equivalent. This eases coordination of benefits and gives other payers the setting information they need. 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. Yes, the cost-share waiver for COVID-19 treatment ended on February 15, 2021. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. Services performed on and after March 1, 2023 would have just their standard timely filing window. For all Optum Behavioral Health commercial plans, any telehealth services provided via a real-time audio and video communication system can be billed for members at home or another location. 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. Activate your myCigna account nowto get access to a virtual dentist. Secure .gov websites use HTTPSA a listing of the legal entities (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.). Billing an evaluation and management (E/M) code when that level of service is not provided is fraudulent billing and is expressly prohibited. 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. Providers can check the Clear Claim ConnectionTM tool on CignaforHCP.com to determine if both the E&M and vaccine administration are allowed for the specific service the provider rendered. Treatment is supportive only and focused on symptom relief. Specimen collection is not generally paid in addition to other services on the same date of service for the same patient whether billed on the same or different claims by the same provider. Get non-narcotic prescriptions sent directly to your local pharmacy, if appropriate. Modifier 95, GT, or GQ must be appended to the virtual care code(s). 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. Previously, these codes were reimbursable as part of our interim COVID-19 accommodations. One of our key goals is to help customers connect to affordable, predictable, and convenient care anytime, anywhere. These codes should be used on professional claims to specify the entity where service (s) were rendered. Yes. Is there a code that we can use to bill for this other than 99441-99443? 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. 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. 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. When a customer receives virtual care services from their regular doctor (or any other provider) as part of this policy and when the provider bills with POS 02 customers with certain benefit plans may have a lower cost-share. Hospitals are still required to make their best efforts to notify Cigna of hospital admissions in part to assist with discharge planning. The COVID-19 billing and reimbursement guidelines that follow are for commercial Cigna medical services, including IFP, unless otherwise noted. 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. 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. Over the past several years and accelerated during COVID-19 we have collaborated with and sought feedback from many local and national medical societies, provider groups in our network, and key collaborative partners that have suggested certain codes and services that should be addressed in a virtual care reimbursement policy. PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. 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. 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. Yes. Telehealth CPT codes 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (20-30 minutes) Reimbursements match similar in-person services, increasing from about $14-$41 to about $60-$137, retroactive to March 1, 2020 3 Biometric screening experience may vary by lab. Cigna allowed providers to bill a standard face-to-face visit for all virtual care services, including those not related to COVID-19, through December 31, 2020 dates of service. POS 02: Telehealth Provided Other than in Patient's Home 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. If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice. All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02. I cannot capture in words the value to me of TheraThink. The codes should not be billed if the sole purpose of the consultation is to arrange a transfer of care or a face-to-face visit. The patient may be either a new patient to the consultant or an established patient with a new problem or an exacerbation of an existing problem. To receive payment equivalent to a normal face-to-face visit you will not bill POS 2 and instead will follow Medicare guidance to bill POS 11 as if care was delivered in the office during COVID-19. For telehealth, the 95 modifier code is used as well. Diagnostic tests, which indicate if the individual carries the virus and can infect others, Serology (i.e., antibody) tests, which indicate if the individual had a previous infection and has now potentially developed an immune response, An individual seeks and receives a COVID-19 diagnostic test from a licensed or authorized health care provider; or, A licensed or authorized health care provider refers an individual for a COVID-19 diagnostic test; and, The laboratory test is FDA approved or cleared or has received Emergency Use Authorization (EUA); and, The test is run in a laboratory, office, urgent care center, emergency room, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU; and, The results of a molecular or antigen test are non-diagnostic for COVID-19 and 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); and. Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna.
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