Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. The covered procedure codes for E-visits/online portal services include: 99421, 99422, 99423, G2061, G2062, G2063. Please visit. No. Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. Yes. 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. List the address of the physician for the telehealth visit on the CMS1500 claim. 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. 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. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. Additionally, when you bill POS 02, your patients may also pay a lower cost-share for the virtual services they receive due to a recent change in some plan benefits. Treatment is supportive only and focused on symptom relief. 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. Free Account Setup - we input your data at signup. However, providers are required to attest that their designated specialty meets the requirements of Cigna. State and federal mandates, as well as customer benefit plan designs, may supersede our guidelines. No waiting rooms. 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. Modifier CR and condition code DR can also be billed instead of CS. An E&M service and COVID-19 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. No. For virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02. A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician. As of February 16, 2021 dates of service, these treatments remain covered, but with standard customer cost-share. Inflammation, sores or infection of the gums, and oral tissues, Guidance on whether to seek immediate emergency care, Board-certified dermatologists review pictures and symptoms; prescriptions available, if appropriate, Care for common skin, hair and nail conditions including acne, eczema, psoriasis, rosacea, suspicious spots, and more, Diagnosis and customized treatment plan, usually within 24 hours. 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). As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. We maintain all current medical necessity review criteria for virtual care at this time. 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. Yes. At this time, providers who offer virtual care will not be specially designated within our public provider directories. When the tests are performed for general population or public health surveillance, for employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19, Cigna will generally not cover in-vitro molecular, antigen, or antibody tests for asymptomatic individuals. Cigna Telehealth Service Effective with January 1, 2021 dates of service, we implemented a new Virtual Care Reimbursement Policy. Coverage reviews for appropriate levels of care and medical necessity will still apply. Cigna will not make any limitation as to the place of service where an eConsult can be used. These include: Virtual preventive care, routine care, and specialist referrals. Yes. The interim COVID-19 virtual care guidelines as outlined on this page were in place for dates of service through December 31, 2020. 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). Specimen collection centers like these can also bill codes G2023 or G2024 following the preceding guidance. Thanks for your help! Please note that certain client exceptions may apply (e.g., clients may opt out of the treatment cost-share waiver or opt-in for an extension of the cost-share waiver). ), Preventive care services (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) [Effective with January 29, 2022 dates of service]. Intake / Evaluation (90791) Billing Guide, Evaluation with Medical Assessment (90792). Cost-share will be waived only when providers bill the appropriate ICD-10 code (U07.1, J12.82, M35.81, or M35.89). 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. Location, other than a hospital or other facility, where the patient receives care in a private residence. 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. When billing, you must use the most appropriate code as of the effective date of the submission. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. ICD-10 diagnosis codes that generally reflect non-covered services are as follows. Please note that state mandates and customer benefit plans may supersede our guidelines. Billing the appropriate administration code will ensure that cost-share is waived. INTERIM TELEHEALTH GUIDANCE Announcement from Cigna Behavioral Health . However, facilities will not be penalized financially for failure to notify us of admissions. 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. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. In addition, the discharging provider or primary care physician can provide the post discharge visit virtually if appropriate. PDF Telehealth/Telemedicine and Telephone Call (Audio Only) Frequently 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. In 2017, Cigna launched behavioral telehealth sessions for all their members. New/Modifications to the Place of Service (POS) Codes for Telehealth This Change Request implements a new POS code (10) for Telehealth, as well as modifies the description for the existing POS code (02) for Telehealth. 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). 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. It's our goal to ensure you simply don't have to spend unncessary time on your billing. As the government is providing the initial vaccine doses free of charge to health care providers, Cigna will not reimburse providers for the cost of the vaccine itself. 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. Audio-only Visits | AAFP Medicare telehealth services practitioners use "02" if the telehealth service is delivered anywhere except for the patient's home. 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. Cigna ultimately looks to the FDA, CDC, and ACIP to determine these factors. Speak with a provider online and discuss your lab work, biometric screenings. October Update: Waivers, NCDs, and POS - AAPC Knowledge Center Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually until further notice. Prior authorization for treatment follows the same protocol as any other illness based on place of service and according to plan coverage. Maybe. The .gov means its official. Cigna remains fully staffed, and is committed to ensuring that precertification requests are reviewed in a timely manner and that there is no interruption of claims processing or claims payments. For the R31 Virtual Care Reimbursement Policy, effective January 1, 2021, we continue to not make any requirements regarding the type of synchronous technology used until further notice. New POS codes Jan 2022 - Navigating the Insurance Maze Locations may have included hospitals, rehabilitation centers, skilled nursing facilities, temporary hospitals, or any other facility where treatment is generally provided. EAP sessions are allowed for telehealth services. 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. A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. Telehealth services not billed with 02 will be denied by the payer. These codes should be used on professional claims to specify the entity where service (s) were rendered. You can call, text, or email us about any claim, anytime, and hear back that day. In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. More information about coronavirus waivers and flexibilities is available on . 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. 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). Comprehensive Outpatient Rehabilitation Facility. End-Stage Renal Disease Treatment Facility. 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. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. 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. When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance. Share sensitive information only on official, secure websites. Below is a definition of POS 02 and POS 10 for CMS-1500 forms, alongside a list of major insurance brands and their changes. A facility that provides the following services: outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically ill, and residents of the CMHC's mental health services area who have been discharged from inpatient treatment at a mental health facility; 24 hour a day emergency care services; day treatment, other partial hospitalization services, or psychosocial rehabilitation services; screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission; and consultation and education services. (Receive an extra 25% off with payment made by Mastercard.) 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. 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. OfficeLink Updates Newsletter Archive | Aetna For costs and details of coverage, review your plan documents or contact a Cigna representative. UPDATED 5/20/20: Telehealth Billing & Coding During COVID-19 All Time (0 Recipes) Past 24 Hours Past Week Past month. Cigna may request the appropriate CLIA-certification or waiver as well as the manufacturer and name of the test being performed. 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. 2 Limited to labs contracted with MDLIVE for virtual wellness screenings. 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. Yes. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing. 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. 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, Most synchronous technology to be used (e.g., FaceTime, Skype, Zoom, etc. Secure .gov websites use HTTPSA As always, we remain committed to providing further updates as soon as they become available. Place of Service Code Set. We are committed to helping providers deliver care how, when, and where it best meets the needs of their patients. Telehealth Services | Aetna Medicaid New Jersey Note that billing B97.29 will not waive cost-share. We will continue to monitor inpatient stays. 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. Please review these changes by going to the Provider FastFax page and selecting fax number 30. Telemedicine Billing Guide & CPT Codes | HealthLens Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. Per usual policy, Cigna does not require three days of inpatient care prior to transfer to a SNF. Congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services. In addition, these requirements must be met: This guidance applies for all providers, including urgent care centers and emergency rooms, and applies to customers enrolled in Cigna's employer-sponsored plans in the United States and the Individual & Family plans available through the Affordable Care Act. And as customers 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. means youve safely connected to the .gov website. 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. Deliver services that are covered by the Virtual Care Reimbursement Policy; Bill consistently with the requirements of the policy; and. Yes. 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. Heres how you know. Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. In addition, Cigna recognizes and expects that providers will continue to follow their usual business practices regarding onboarding new providers, locum tenens, and other providers brought in to cover practices or increase care during times of high demand. My daily insurance billing time now is less than five minutes for a full day of appointments. Customers will be referred to seek in-person care. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. Inpatient COVID-19 care that began on or before February 15, 2021, and continued on or after February 16, 2021 at the same facility, will have cost-share waived for the entire course of the facility stay.