Cigna will determine coverage for each test based on the specific code(s) the provider bills. This coverage began January 15, 2022 and continues through at least the end of the public health emergency (PHE) period (May 11, 2023). Yes. You get connected quickly. Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. Previously, these codes were reimbursable as part of our interim COVID-19 accommodations. All other customers will have the same cost-share as if they received the services in-person from that same provider. Talk privately with a licensed therapist or psychiatrist by appointment using your phone, tablet, or computer. This eases coordination of benefits and gives other payers the setting information they need. Per usual protocol, emergency and inpatient imaging services do not require prior authorization. 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. 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. Talk to board-certified dermatologists without an appointment for customized care for skin, hair, and nail conditions. All Cigna Customers will pay $0 ingredient cost while funded by government, while Cigna commercial customers will pay up to a $6 dispensing fee when obtained at a pharmacy where the medications are available. Non-contracted providers should use the Place of Service code they would have used had the . Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. If you are rendering services as part of a facility (i.e., intensive outpatient program . Yes. 24/7, live and on-demand for a variety of minor health care questions and concerns. Locations may have included hospitals, rehabilitation centers, skilled nursing facilities, temporary hospitals, or any other facility where treatment is generally provided. Therefore, FaceTime, Skype, Zoom, etc. Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. Listing Results Cigna Telehealth Place Of Service. Intermediate Care Facility/ Individuals with Intellectual Disabilities. 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. Yes. Cigna will reimburse Remdesivir for COVID-19 treatment when administered in inpatient or outpatient settings at the national CMS reimbursement rate (or average wholesale pricing [AWP] if a CMS rate is not available) when the drug costs are not included in case rates or per diems to ensure timely, consistent, and reasonable reimbursement. How Can You Tell Which Specific Technology is Reimbursable? 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. (Description change effective January 1, 2016). The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. 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. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. Please note that some opt-outs for self-funded benefit plans may have applied. codes and normal billing procedures. Please note that we continue to closely monitor and audit claims for inappropriate services that could not be performed virtually (e.g., acupuncture, all surgical codes, anesthesia, radiology services, laboratory testing, administration of drugs and biologics, infusions or vaccines, EEG or EKG testing, etc.). 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. No. No. Cigna commercial and Cigna Medicare Advantage will waive the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. 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). All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. Yes. PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. Antibody tests: 86328, 86769, 86408, 86409, 86413, and 0224U, Cigna covers diagnostic molecular and antigen tests for COVID-19 through at least. The change in the telehealth policy will take effect on January 1, 2022, and be implemented on April 4, 2022. ICD-10 diagnosis codes that generally reflect non-covered services are as follows. 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 billing, you must use the most appropriate code as of the effective date of the submission. Billing an evaluation and management (E/M) code when that level of service is not provided is fraudulent billing and is expressly prohibited. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. On July 2, 2021 MVP announced changes to member cost-share effective August 1, 2021. 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. Yes, the cost-share waiver for COVID-19 treatment ended on February 15, 2021. CMS now defines these two telemedicine place of service (POS) codes: POS 02: Telehealth Provided Other than in Patient's Home Descriptor: The location where health services and health related services are provided or received, through telecommunication technology. Providers should bill the relevant vaccine administration code (e.g., 0001A, 0002A, etc.) Cigna commercial and Cigna Medicare Advantage customers receive the COVID-19 vaccine with no out-of-pocket costs; and. This is an extenuating circumstance. A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients. 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. 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 facility (place of service 32), or to an individuals home (place of service 12) to collect the specimen. Providers can, however, bill the vaccine code (e.g., 91300 for the Pfizer vaccine or 91301 for the Moderna vaccine) with a nominal charge (e.g., $.01), but it is not required to be billed in order to receive reimbursement for the administration of the vaccine. Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. CMS officially has designated a Place of Service code for all of the telehealth to be "02" starting April 1, 2020. 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. 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. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. 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. List the address of the physician for the telehealth visit on the CMS1500 claim. No. Please note that this list is not all inclusive and may not represent an exact indication match. Yes. Please review our COVID-19 In Vitro Diagnostic Testing coverage policy for a list of additional services and ICD-10 codes that are generally not covered. For telephone services only, codes are time based. Neither U0003 nor U0004 should be used for tests that are used to detect COVID-19 antibodies. Yes. Free Account Setup - we input your data at signup. We are committed to helping providers deliver care how, when, and where it best meets the needs of their patients. If a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. We are your billing staff here to help. 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. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. 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. Providers will continue to be reimbursed at 100% of their face-to-face rates for covered virtual care services, even when billing POS 02. Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. These include: Virtual preventive care, routine care, and specialist referrals. Unless your office was approved to be a facility to administer virtual patient care, then it is best to bill using the telehealth code (11) Office. Yes. 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). 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. Specialist to specialist (e.g., ophthalmologist requesting consultation from a retina specialist, orthopedic surgeon requesting consultation from an orthopedic surgeon oncologist, cardiologist with an electrophysiology cardiologist, and obstetrician from a maternal fetal medicine specialist), Hospitalist requests an infectious disease consultation for pulmonary infections to guide antibiotic therapy, The ICD-10 code that represents the primary condition, symptom, or diagnosis as the purpose of the consult; and. Services include methadone and other forms of Medication Assisted Treatment (MAT). Cigna waived cost-share for COVID-19 related treatment, in both inpatient and outpatient settings, through February 15, 2021 dates of service. When the condition being billed is a post-COVID condition, please submit using ICD-10 code U09.9 and code first the specific condition related to COVID-19. 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. new codes. An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. As of February 16, 2021 dates of service, these treatments remain covered, but with standard customer cost-share. Please note that all technology used must be secure and meet or exceed federal and state privacy requirements. Maybe. Considering the pressure facilities are under, Cigna will extend the authorization approval window from three months to six months on request. We do not expect smaller laboratories or doctors' offices to be able to perform these tests. Yes. Consistent with federal guidelines for private insurers, Cigna commercial will cover up to eight over-the-counter (OTC) diagnostic COVID-19 tests per month (per enrolled individual) with no out-of-pocket costs for claims submitted by a customer under their medical benefit. 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. For example, an infectious disease specialist could provide a virtual consultation for an ICU patient, document the level of care provided, bill the appropriate face-to-face E&M code with modifier GQ, GT, or 95, and be reimbursed at the face-to-face rate. New and revised codes are added to the CPBs as they are updated. POS 10 Telehealth provided in a patient's home was created for services provided remotely to a patient in their private residence. As a result, we did not reimburse for the drug itself when billed with Q0222.However, on August 15, drug manufacturer Eli Lilly started commercial distribution of their COVID-19 monoclonal antibody therapy, bebtelovimab (175 mg), and the federal government will no longer purchase it. 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. Cigna will not reimburse providers for the cost of the vaccine itself. Last updated February 15, 2023 - Highlighted text indicates updates. The following Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes are used to bill for telebehavioral and telemental health services and have been codified into the current Medicare Physician Fee Schedule (PFS). 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. Please review these changes by going to the Provider FastFax page and selecting fax number 30. 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 implemented a Virtual Care Reimbursement Policy for commercial medical services, effective January 1, 2021.1 This policy ensures you can continue to receive ongoing reimbursement for virtual care provided to your patients with Cigna commercial medical coverage.2. For providers whose contracts utilize a different reimbursement 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. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. A facility maintained by either State or local health departments that provides ambulatory primary medical care under the general direction of a physician. Yes. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. The Administration's plan is to end the COVID-19 public health emergency (PHE) on May 11, 2023. However, this added functionality is planned for a future update. 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 A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. Cigna will only reimburse claims for covered OTC COVID-19 tests submitted by customers under their medical benefit and by certain pharmacy retailers under the pharmacy benefit, as elected by clients. As of January 1, 2022, a new POS code has been approved to report more specifically where services were provided. 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. 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. 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. Modifier 95, GT, or GQ must be appended to the appropriate CPT or HCPCS procedure code(s) to indicate the service was for virtual care. Please visit CignaforHCP.com/virtualcare for additional information about that policy. 24/7, live and on-demand for a variety of minor health care questions and concerns. Activate your myCigna account nowto get access to a virtual dentist. A walk-in health clinic, other than an office, urgent care facility, pharmacy or independent clinic and not described by any other Place of Service code, that is located within a retail operation and provides, on an ambulatory basis, preventive and primary care services. No. The POS Workgroup is revising the description of POS code 02 and creating a new POS code 10 to meet the overall industry needs, as follows: 1. The location where health services and health related services are provided or received, through telecommunication technology. NOTE: As of March 2020, Cigna has waived their attestation requirements however we always recommend calling Cigna or any insurance company to complete an eligibility and benefits verification to ensure your telehealth claims will process through to completion. 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. This includes: Please refer to the interim COVID-19 virtual care guidelines for a complete outline of our interim COVID-19 virtual care coverage. 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).