Separate codes providers may use to bill for supplies are generally considered incidental to the overall primary service and are not reimbursed separately. 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). Cigna will accept roster billing from providers who are already mass immunizers and bill Cigna today in this way for other vaccines (e.g., seasonal flu vaccine), as well as from providers and state agencies that are offering mass vaccinations for their local communities, provided the claim roster includes sufficient information to identify the Cigna customer. In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. Cigna may request the appropriate CLIA-certification or waiver as well as the manufacturer and name of the test being performed. CMS officially has designated a Place of Service code for all of the telehealth to be "02" starting April 1, 2020. Schedule an appointment online with MDLIVE and visit a lab for your blood work and biometrics. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. No. The COVID-19 billing and reimbursement guidelines that follow are for commercial Cigna medical services, including IFP, unless otherwise noted. Generally, only well-equipped commercial laboratories and hospital-based laboratories will have the necessary equipment to offer these tests. Providers can call Cigna customer service at 1.800.88Cigna (882.4462) to check a patients eligibility information, including if their plan offers coverage for these purposes. We continue to make several other accommodations related to virtual care until further notice. Services include physical therapy, occupational therapy, and speech pathology services. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. Similar to other vaccination administration (e.g., a flu shot), an E&M service and vaccine administration code should only be billed when a significant and separately identifiable E&M visit was performed at the same time as the administration of the vaccine. Product availability may vary by location and plan type and is subject to change. Per usual policy, Cigna does not require three days of inpatient care prior to transfer to a SNF. The codes may only be billed once in a seven day time period. Cigna offers a number of virtual care options depending on your plan. No. This article was updated on March 28, 2020 by adding a link to American Specialty Health and updating the place of service code to use on the 1500-claim form. Listed below are place of service codes and descriptions. Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours. All synchronous technology used must be secure and meet or exceed federal and state privacy requirements. This new initiative enables payment from original Medicare for submitted claims directly to participating eligible pharmacies and other health care providers, which allows Medicare beneficiaries to receive tests at no cost. To speak with a dentist,log in to myCigna. This will allow for quick telephonic consultations related to COVID-19 screening or other necessary consults, and will offer appropriate reimbursement to providers for this amount of time. Yes. Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF). 2 Limited to labs contracted with MDLIVE for virtual wellness screenings. Other Reimbursement Type. 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. Cost share is waived for all covered eConsults through December 31, 2021. When multiple services are billed along with S9083, only S9083 will be reimbursed. 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. Hospitals are still required to make their best efforts to notify Cigna of hospital admissions in part to assist with discharge planning. In order to bill these codes, the test must be FDA approved or cleared or have received Emergency Use Authorization (EUA). 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. Urgent care centers can also bill their typical S9083 code for services that are more complex than a quick telephone call. 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. Place of Service Code Set. Yes. To sign up for updates or to access your subscriber preferences, please enter your contact information below. When billing, you must use the most appropriate code as of the effective date of the submission. Download and . 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. Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. on the guidance repository, except to establish historical facts. 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). 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. 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. No. At this time, providers who offer virtual care will not be specially designated within our public provider directories. Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. 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. If antibodies are present, it means that individual previously had a specific viral or bacterial infection - like COVID-19. When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance. Please note that state mandates and customer benefit plans may supersede our guidelines. The interim COVID-19 virtual care guidelines were solely in place through December 31, 2020, and this new policy took effect on January 1, 2022. "Medicare hasn't identified a need for new POS code 10. Treatment is supportive only and focused on symptom relief. For telehealth, the 95 modifier code is used as well. 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. Yes. This eases coordination of benefits and gives other payers the setting information they need. 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. Yes. M0222 (administration in facility setting): $350.50, M0223 (administration in home setting): $550.50. 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. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. 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. When no specific contracted rates are in place, we will reimburse this code at $22.99 consistent with CMS pricing to ensure consistent, timely, and reasonable reimbursement. 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 Additionally, certain virtual care services and accommodations that are not generally reimbursable under the Virtual Care Reimbursement Policy remain reimbursable as part of our continued interim COVID-19 virtual care guidelines until further notice. 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. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology. As of July 1, 2022, we request that providers bill with POS 02 for all virtual care. This guidance applies to all providers, including laboratories. This includes providers who typically deliver services in a facility setting. On-demand virtual care for minor medical conditions, Talk therapy and psychiatry from the privacyof home. No additional modifiers are necessary to include on the claim. Cigna will not make any limitation as to the place of service where an eConsult can be used. There may be limited exclusions based on the diagnoses submitted. Recently, the Centers for Medicare & Medicaid Services (CMS) introduced a new place-of-service (POS) code and revised another POS code in an effort to improve the reporting of telehealth services provided to patients at home as well as the coverage of telebehavioral health. 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. Yes. 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. Per CMS, U0003 and U0004 should be used to bill for tests that would typically be billed by 87635 and U0002 respectively, except for when the tests are performed with these high-throughput technologies. Toll Free Call Center: 1-877-696-6775. These codes are used to report episodes of patient care initiated by an established patient or guardian of an established patient. 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. 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. Cost-share will be waived for COVID-19 related services only when providers bill the appropriate ICD-10 code and modifier CS. We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. 3 Biometric screening experience may vary by lab. Yes. No. 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. 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. Yes. 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. A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. 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). When specific contracted rates are in place for COVID-19 specimen collection services, Cigna will reimburse covered services at those contracted rates. Modifier CR or condition code DR can also be billed instead of CS. More information about coronavirus waivers and flexibilities is available on . As of April 1, 2021, Cigna resumed standard authorization requirements. You can decide how often to receive updates. You'll always be able to get in touch. We are your billing staff here to help. For details, see the CMS document titled Place of Service Codes for Professional Claims Database (updated September 2021). * POS code 10 POS code name Urgent care centers will not be reimbursed separately when they bill for multiple services. 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. If a provider was reimbursed for a face-to-face service per their existing fee schedule, then they were reimbursed the same amount even if they delivered the service virtually. Customers will be referred to seek in-person care. representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). Service performed: OEce or other outpatient visit for the evaluation and management of a new patient CPT code billed: 99202 Modier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): 100% of face-to-face rate Customer cost-share: Applies consistent with 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. 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. 24/7, live and on-demand for a variety of minor health care questions and concerns. These codes should be used on professional claims to specify the entity where service (s) were rendered. 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. 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). No. Billing guidelines: Optum Behavioral Health will reimburse telehealth services which use standard CPT codes and a GT modifier or a Place of Service of 02 for When providers purchase the drug itself from the manufacturer (e.g., bebtelovimab billed with Q0222), Cigna will reimburse the cost of the drug when covered. 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. On Aug. 3, 2020 CMS published a revision to the April 27th, 2020 memo announcing the addition of telephonic CPT codes (98966-98968, 99441-99443) valid for 2020 benefit year data submissions for the Department of Health and Human Services- (HHS-) operated risk adjustment program. A facility, other than a hospital's maternity facilities or a physician's office, which provides a setting for labor, delivery, and immediate post-partum care as well as immediate care of new born infants. These codes should be used on professional claims to specify the entity where service (s) were rendered. Providers should bill one of the above codes, along with: No. Patient is not located in their home when receiving health services or health related services through telecommunication technology. For more information, including details on how you can get reimbursed for these tests from original Medicare when you directly supply them to your patients with Part B or Medicare Advantage plans, please, U0003: $75 per test (high-throughput PCR-based coronavirus test)*, U0004: $75 per test (any technique with high-throughput technology)*, U0005: $25 (when test results are returned within two days)*, Routine and/or executive physicals (Z02.89). Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? The Department may not cite, use, or rely on any guidance that is not posted As of February 16, 2021 dates of service, cost-share applies. No. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. Under My Account > Settings > Practice Details, you can select the Insurance Place of Service code associated with sessions held via video. Free Account Setup - we input your data at signup. For telephone services only, codes are time based. Effective January 1, 2021, we implemented a new. Your access portal for updated claims and reports is secured via our HTTPS/SSL/TLS secured server. A federal government website managed by the Cigna remains adequately staffed to respond to all new precertification requests for elective procedures within our typical timelines. When specific contracted rates are in place for COVID-19 vaccine administration services, Cigna will reimburse covered services at those contracted rates. The ICD-10 codes for the reason of the encounter should be billed in the primary position. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 Please note that we continue to request that providers do not bill with modifiers 93 or FQ at this time. 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. Note: We only work with licensed mental health providers. When all requirements are met, covered services are currently reimbursed at 100% of face-to-face rates (i.e., parity). No virtual care modifier is needed given that the code defines the service as an eConsult. Total 0 Results. Modifier CS for COVID-19 related treatment. State and federal mandates, as well as customer benefit plan designs, may supersede our guidelines. 1 In an emergency, always dial 911 or visit the nearest hospital. 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. A medical facility operated by one or more of the Uniformed Services. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. 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 . As always, we remain committed to providing further updates as soon as they become available. 1 Billing Guidelines: Optum will reimburse telehealth services which use standard CPT codes for outpatient treatment and a GT, GQ or 95 modifier for either a video-enabled virtual visit or a telephonic session, to indicate the visit was conducted remotely. We are awaiting further billing instructions for providers, as applicable, from CMS. For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. A facility, other than a patient's home, in which palliative and supportive care for terminally ill patients and their families are provided. Services include methadone and other forms of Medication Assisted Treatment (MAT). Virtual care offered by Urgent Care Centers billing with code S9083 is reimbursable until further notice. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Please review the Virtual Care Reimbursement Policy for additional details on the added codes. 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). For virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02. In addition to the in-office care that you deliver today, we encourage you to consider offering virtual care to your patients with Cigna coverage as well and ensure theyre aware that you can continue to offer ongoing covered virtual care as they need it and as its medically appropriate. Therefore, please refer to those guidelines for services rendered prior to January 1, 2021. . Here is a complete list of place of service codes: Place of Service Codes. Providers billing under an 837P/1500 must include the place of service (POS) code 02 when submitting claims for services delivered via telehealth. Cigna will determine coverage for each test based on the specific code(s) the provider bills. Yes. Please note that while virtual care services billed on a UB-04 claim will not typically be reimbursed under this policy, we continue to reimburse virtual care services billed on a UB-04 claim form until further notice as a COVID-19 accommodation when the services: Please note that existing reimbursement policies will apply and may affect claims payment (e.g., R30 E&M Services). 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. 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. Our mental health insurance billing staff is on call Monday Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy. 31, 2022. 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. Cost-share is waived only when billed by a provider or facility without any other codes. 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). Obtain your Member Code with just HK$100. This will help us to meet customers' clinical needs and support safe discharge planning. 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. Before sharing sensitive information, make sure youre on a federal government site. 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. Cost-share was waived through February 15, 2021 dates of service. 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. INTERIM TELEHEALTH GUIDANCE Announcement from Cigna Behavioral Health . 1995-2020 by the American Academy of Orthopaedic Surgeons. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. For more information about current Evernorth Behavioral Health virtual care guidance, please visit CignaforHCP.com > Resources > Behavioral Resources > Doing Business with Cigna >, For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com >, Outpatient E&M codes for new and established patients (99202-99215), Physical and occupational therapy E&M codes (97161-97168), Annual wellness visit codes (G0438 and G0439), Services must be on the list of eligible codes contained within in our. ), Preventive care services (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) [Effective with January 29, 2022 dates of service]. 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. Please note that all technology used must be secure and meet or exceed federal and state privacy requirements. Excluded physician services may be billed Activate your myCigna account nowto get access to a virtual dentist. Yes. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. We do not expect smaller laboratories or doctors' offices to be able to perform these tests. For telehealth services rendered by a facility provider, report the CPT/HCPCS code with the applicable revenue code as would normally be done for an in-person visit, and also append either modifier 95 or GT. No. You can call, text, or email us about any claim, anytime, and hear back that day. Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually until further notice. We also continue to work directly with providers to understand the financial implications that virtual care reimbursement may have on practices.