However, we believe that FDA and EUA-approved vaccines are safe and effective, and encourage our customers to get vaccinated. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. If antibodies are present, it means that individual previously had a specific viral or bacterial infection - like COVID-19. 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 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. On July 2, 2021 MVP announced changes to member cost-share effective August 1, 2021. No virtual care modifier is needed given that the code defines the service as an eConsult. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. 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. 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. Please note that some opt-outs for self-funded benefit plans may have applied. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. 24/7, live and on-demand for a variety of minor health care questions and concerns. Residential Substance Abuse Treatment Facility. Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. For covered virtual care services cost-share will apply as follows: No. In all cases, reimbursement will only be provided for hospital outpatient services performed in a clinic setting (including drive-thru testing sites) when billed on a UB-04 claim form with an appropriate revenue code. 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. Audio-only encounters can be provided using the telephone evaluation and management codes (CPT codes. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. 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). When no specific contracted rates are in place, Cigna will reimburse all covered COVID-19 diagnostic tests consistent with CMS reimbursement to ensure consistent, timely, and reasonable reimbursement. Please review the Virtual care services frequently asked questions section on this page for more information. This will help with tracking purposes, and ensure timely reimbursement for the administration of the treatment. 1 In an emergency, always dial 911 or visit the nearest hospital. Phone, video, FaceTime, Skype, Zoom, etc. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. Comprehensive Outpatient Rehabilitation Facility. Youll receive a summary of your screening results for your records. Yes. Diluents are not separately reimbursable in addition to the administration code for the infusion. codes and normal billing procedures. Washington, D.C. 20201 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. Providers should bill the pre-admission or pre-surgical testing of COVID-19 separately from the surgery itself using ICD-10 code Z01.812 in the primary position. When a claim is submitted by the facility the patient was transferred to (e.g., SNF, AR, or LTACH), the facility should note that the patient was transferred to them without an authorization in an effort to quickly to free up bed space for the transferring facility. Cigna ultimately looks to the FDA, CDC, and ACIP to determine these factors. 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). Through December 31, 2020 dates of service, providers could deliver virtual neuropsychological and psychological testing services and bill their regular face-to-face CPT codes that were on their fee schedule . 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. COVID-19 OTC tests used for employment, travel, participation in sports or other activities are not covered under this mandate. 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. You can call, text, or email us about any claim, anytime, and hear back that day. Thanks for your help! A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. Secure .gov websites use HTTPSA In addition, Anthem would recognize telephonic-only . When no contracted rates are in place, Cigna will reimburse covered diagnostic serology laboratory tests consistent with CMS reimbursement, including $42.13 for code 86769 and $45.23 for code 86328, to ensure consistent, timely, and reasonable reimbursement. Yes. 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. Please visit. (Effective January 1, 2016). To speak with a dentist,log in to myCigna. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. When billing for the service, indicate the place of service as where the visit would have occurred if in person. 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. 31, 2022. The COVID-19 billing and reimbursement guidelines that follow are for commercial Cigna medical services, including IFP, unless otherwise noted. 1995-2020 by the American Academy of Orthopaedic Surgeons. Cigna will determine coverage for each test based on the specific code(s) the provider bills. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. The ordering provider should use the standard, existing process to submit home health orders to eviCore healthcare. 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. 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 . Most mental health providers will be furnishing services using Place of Service code 10 (POS 10) when providing telehealth services. What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? Store and forward communications (e.g., email or fax communications) are not reimbursable. For virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02. Yes. Previously, these codes were reimbursable as part of our interim COVID-19 accommodations. 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. Cigna does not require prior authorization for home health services. Service codes Physicians: use service codes 99441-99443; Non-physicians: use 98966-98968 We're waiving copays for telehealth visits for behavioral and mental health counseling for members eligible for managed long-term services and supports (MLTSS) and Division of Developmental . 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. 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. For details, see the CMS document titled Place of Service Codes for Professional Claims Database (updated September 2021). 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. In addition, it's my interpretation that Cigna is only paying for telehealth services for physical, occupational and speech therapy submitted on a 1500-claim form by a private practice. An official website of the United States government. These codes are used to report episodes of patient care initiated by an established patient or guardian of an established patient. Please note that our interim COVID-19 virtual care guidelines were in place until December 31, 2020. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. 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 test is FDA approved or cleared or have received Emergency Use Authorization (EUA); The test is run in a laboratory, office, urgent care center, emergency room, drive-thru testing site, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU. Please review the Virtual care services frequently asked questions section on this page for more information. 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. Cigna understands the tremendous pressure our healthcare delivery systems are under. eConsult services remain covered; however, customer cost-share applies as of January 1, 2022. 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. For the purposes of private practice, the three most common service codes therapists are likely to bill are "11" (office), "12" (in-home services), and "2" (telehealth). However, providers are required to attest that their designated specialty meets the requirements of Cigna. On-demand virtual care for minor medical conditions, Talk therapy and psychiatry from the privacyof home. Additionally, Cigna also continues to provide coverage for COVID-19 tests that are administered with a providers involvement or prescription after individualized assessment as outlined in this section and in Cignas COVID-19 In Vitro Diagnostic Testing coverage policy. Effective January 1, 2021, we implemented a new. To this end, we will use all feedback we receive to consider further updates to our policy. Telehealth (also referred to as telemedicine) gives our members access to their health care provider from their home or another location. 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. Instead, U07.1, J12.82, M35.81, or M35.89 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnosis. Cigna recommends video services but allows telephonic sessions; however they may require review for medical necessity. 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. As of April 1, 2021, Cigna resumed standard authorization requirements. For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. 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 Cigna will not reimburse providers for the cost of the vaccine itself. 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. An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. 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. Cigna covered the administration and post-administration monitoring of EUA-approved COVID-19 infusion treatments with no customer-cost share for services provided through February 15, 2021. lock Therefore, as of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. Talk to board-certified dermatologists without an appointment for customized care for skin, hair, and nail conditions. DISCLAIMER: The contents of this database lack the force and effect of law, except as While services billed on a UB-04 are out of scope for the new policy, we will continue to evaluate facility-based services for future policy updates. We recommend providers bill POS 02 beginning July 1, 2022 for virtual services (instead of a face-to-face POS). We will continue to assess the situation and adjust to market needs as necessary. 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. A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. 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. Listed below are place of service codes and descriptions. It's our goal to ensure you simply don't have to spend unncessary time on your billing. Therefore, effective with August 15 dates of service, Cigna will reimburse providers consistent with CMS rates for doses of bebtelovimab that they purchase directly from the manufacturer. website belongs to an official government organization in the United States. In certain cases, yes. When an order for home health services is clinically appropriate for telehealth services, the care will be offered through a virtual visit unless the order indicates that home health services must be in-person or the patient refuses the virtual visit. No. We are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. Yes. Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually until further notice. When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9. As private practitioners, our clinical work alone is full-time. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. 2. A facility which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital. 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. Cigna does require prior authorization for fixed wing air ambulance transport. Usually not. Urgent care centers can also bill their typical S9083 code for services that are more complex than a quick telephone call. For additional information about our Virtual Care Reimbursement Policy, providers can contact their provider representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). While as part of this policy, Urgent Care centers billing virtual care on a global S code is not reimbursable, we do continue to reimburse these services until further notice as part of our interim COVID-19 guidelines. For COVID-19 related screening (i.e., quick phone or video consult): No cost-share for customers through at least, For non-COVID-19 related services (e.g., oncology visit, routine follow-up care): Standard customer cost-share. The interim COVID-19 virtual care guidelines as outlined on this page were in place for dates of service through December 31, 2020.