Listed below are place of service codes and descriptions. 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 all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. If more than one telephone, Internet, or electronic health record contact(s) is required to complete the consultation request (e.g., discussion of test results), the entirety of the service and the cumulative discussion and information review time should be billed with a single code. Cost share is waived for all covered eConsults through December 31, 2021. 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. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with the CMS reimbursement rates noted below to ensure timely, consistent and reasonable reimbursement. Previously, these codes were reimbursable as part of our interim COVID-19 accommodations. Cost-share is waived when G2012 is billed for COVID-19 related services consistent with our, ICD-10 code Z03.818, Z11.52, Z20.822, or Z20.828, POS 02 and GQ, GT, or 95 modifier for virtual care. 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. This form can be completed here:https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf. As of July 1, 2022, we request that providers bill with POS 02 for all virtual care. An official website of the United States government Our data is encrypted and backed up to HIPAA compliant standards. Services performed on and after March 1, 2023 would have just their standard timely filing window. While virtual care provided by an urgent care center is not covered per our R31 Virtual Care Reimbursement Policy, we continue to reimburse urgent care centers for delivering virtual care until further notice as part of our interim COVID-19 virtual care accommodations. 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 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. 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. Official websites use .govA Yes. Cigna will generally not cover molecular, antigen, or antibody tests for asymptomatic individuals 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. Therefore, FaceTime, Skype, Zoom, etc. For services provided through February 15, 2021, providers will need to bill consistent with our interim billing guidelines by including the Diagnosis code (Dx) U07.1, J12.82, M35.81, or M35.89 on claims related to the treatment of COVID-19. Store and forward communications (e.g., email or fax communications) are not reimbursable. 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. COVID-19 admissions would be emergent admissions and do not require prior authorizations. For example, if a dietician or occupational therapist would typically see a patient in an outpatient setting, but that service is now provided virtually, that dietician or occupational therapist would bill the same way they do for that face-to-face visit using the existing codes on their fee schedule and existing claim form they typically bill with (e.g., CMS 1500 or UB-04) and append the GQ, GT, or 95 modifier. Subscribe now with just HK$100. Bill those services on a CMS-1500 form or electronic equivalent. Heres how you know. For example, if a patient presents at an emergency room with a suspected broken ankle after a fall and is also tested for COVID-19 during the visit, Cigna would cover services related to treating the ankle at standard customer cost-share, while the COVID-19 laboratory test would be covered at no customer cost-share. In addition, the discharging provider or primary care physician can provide the post discharge visit virtually if appropriate. 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. No. This is true for Medicare or other insurance carriers. When multiple services are billed along with S9083, only S9083 will be reimbursed. Cigna recommends video services but allows telephonic sessions; however they may require review for medical necessity. Last updated February 15, 2023 - Highlighted text indicates updates. Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; 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. Yes. 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. While the policy - announced in United's . Yes. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. Please note that customer cost-share and out-of-pocket costs may vary for services customers receive through our virtual care vendor network (e.g., MDLive). A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. All Cigna pharmacy and medical plans will cover Paxlovid and molnupiravir at any pharmacy or doctors office (in- or out-of-network) that has them available. For virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. No virtual care modifier is needed given that the code defines the service as an eConsult. Yes. Audio -only CPT codes 98966 98968 and 99441 Area (s) of Interest: Payor Issues and Reimbursement. This will help with tracking purposes, and ensure timely reimbursement for the administration of the treatment. You get connected quickly. Non-residential Substance Abuse Treatment Facility, Non-residential Opioid Treatment Facility, A location that provides treatment for opioid use disorder on an ambulatory basis. It remains expected that the service billed is reasonable to be provided in a virtual setting. Yes. The U.S. Food and Drug Administration (FDA) recently approved for emergency use two prescription medications for the treatment of COVID-19: PaxlovidTM (from Pfizer) and molnupiravir (from Merck). Beginning January 15, 2022, and through at least the end of the PHE (. These codes should be used on professional claims to specify the entity where service (s) were rendered. 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. Is Face Time allowed? All Rights Reserved. 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. Reimbursement will be consistent as though they performed the service in a face-to-face setting. As of January 1, 2022, a new POS code has been approved to report more specifically where services were provided. 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. 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. 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 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. A facility other than a hospital, which provides dialysis treatment, maintenance, and/or training to patients or caregivers on an ambulatory or home-care basis. A facility whose primary purpose is education. For costs and details of coverage, review your plan documents or contact a Cigna representative. Ultimately however, care must be medically necessary to be covered. 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. We continue to monitor for any updates from the administration and are evaluating potential changes to our ongoing COVID-19 accommodations as a result of the PHE ending. Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. 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. Listed below are place of service codes and descriptions. https:// Under My Account > Settings > Practice Details, you can select the Insurance Place of Service code associated with sessions held via video. Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. 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. (99441, 98966, 99442, 98967, 99334, 98968). Certain PT, OT, and ST virtual care services remain reimbursable under the R31 Virtual Care Reimbursement Policy. eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. Modifier CS for COVID-19 related treatment. If a hospitalist is the treating provider, they would not be reimbursed for two services on the same day, as only one service is reimbursed per day, regardless of billing method. The site is secure. Intermediate Care Facility/ Individuals with Intellectual Disabilities. 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. A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided. Modifier 95, GT, or GQ must be appended to the virtual care code(s). 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. We will continue to assess the situation and adjust to market needs as necessary. Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. Providers will continue to be reimbursed at 100% of their face-to-face rates for covered virtual care services, even when billing POS 02. No. 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. Yes. Additional FDA EUA approved vaccines will be covered consistent with this guidance. Providers billing under an 837P/1500 must include the place of service (POS) code 02 when submitting claims for services delivered via telehealth. 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. Customer cost-share will be waived for COVID-19 related virtual care services through at least. An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. TheraThink.com 2023. Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. Yes. These include: Virtual preventive care, routine care, and specialist referrals. 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. Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually until further notice. Telephone, Internet, or electronic health record consultations of less than five minutes should not be billed. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). 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. For telephone services only, codes are time based. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 No. Cigna covers the administration of the COVID-19 vaccine with no customer cost-share (i.e., no deductible or co-pay) when delivered by any provider or pharmacy. If an urgent care center performs an evaluation and treatment service, collects a specimen for COVID-19, and runs the laboratory test, they should bill just their per-visit S9083 code or just the laboratory code. 200 Independence Avenue, S.W. Please visit. No. (As of 01/21/2021) What Common Procedural Technology (CPT) codes should be used for COVID-19 testing? 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. 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. 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. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. Talk privately with a licensed therapist or psychiatrist by appointment using your phone, tablet, or computer. Providers who are administering the COVID-19 vaccine in a site other than their typical office or facility setting (e.g., at a sports complex) can bill us under their regular facility location. Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. We are your billing staff here to help. We are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. 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. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. Anthem would recognize IOP services that are rendered via telehealth with a revenue code (905, 906, 912, 913), plus CPT codes for specific behavioral health services. MLN Matters article MM12549, CY2022 telehealth update Medicare physician fee schedule. This guidance applies to all providers, including laboratories. Our policy allows for reimbursement of a variety of services typically performed in an office setting that are appropriate to also perform virtually. Cigna will allow reimbursement for these codes by any provider or facility only when billed without any other codes (except where the contract allows it). The Virtual Care Reimbursement Policy also applies to non-participating providers. 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. Therefore, we will not enforce an administrative denial for failure to secure authorization (FTSA)on appeal if an extenuating circumstance due to COVID-19 applied. To this end, we will use all feedback we receive to consider further updates to our policy. A facility which primarily provides health-related care and services above the level of custodial care to individuals but does not provide the level of care or treatment available in a hospital or SNF. For all other IFP plans outside of Illinois, primary care physicians are still encouraged to coordinate care and assist in locating in-network specialists, but the plans no longer have referral requirements as of January 1, 2021. Antibody tests: 86328, 86769, 86408, 86409, 86413, and 0224U, Cigna covers diagnostic molecular and antigen tests for COVID-19 through at least. At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. More information about coronavirus waivers and flexibilities is available on . Total 0 Results. Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours. However, we believe that FDA and EUA-approved vaccines are safe and effective, and encourage our customers to get vaccinated. Urgent Care vs. the Emergency Room7 Ways to Help Pay Less for Out-of-Pocket Costs, What is Preventive Care?View all articles. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. Recent guidelines have recommended keeping the normal service facility that you are registered under in your CMS-1500. Share sensitive information only on official, secure websites. 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 . We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice. Similarly, if a cardiologist is brought in to consult in a face-to-face setting within a facility setting, that cardiologist can also provide services virtually billing a face-to-face evaluation and management (E&M) visit (the same code[s] on their fee schedule and the same claim form [e.g., CMS 1500 or UB-04]). The Department may not cite, use, or rely on any guidance that is not posted U.S. Department of Health & Human Services Yes. 1 over a 7-day period. For providers whose contracts utilize a different reimbursement 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. The covered procedure codes for E-visits/online portal services include: 99421, 99422, 99423, G2061, G2062, G2063. You can call, text, or email us about any claim, anytime, and hear back that day. Providers could deliver any face-to-face service on their fee schedule virtually, including those not related to COVID-19, for dates of service through December 31, 2020. The accelerated credentialing accommodation ended on June 30, 2022. CMS officially has designated a Place of Service code for all of the telehealth to be "02" starting April 1, 2020. Primary care physician to specialist requesting input from a cardiologist, psychiatrist, pulmonologist, allergist, dermatologist, surgeon, oncologist, etc. NOTE: Please direct questions related to billing place of service codes to your Medicare Administrative Contractor (MAC) for assistance. For additional information about our coverage of the COVID-19 vaccine, please review our. Following the recent statement from the National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel indicating that a three-dose regimen of Remdesivir in the outpatient setting can be effective in preventing progression to severe COVID-19, CMS created HCPCS code J0248 when administering Remdesivir in an outpatient setting. 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. M misstigris Networker Messages 63 Location Portland, OR 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. 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. Place of Service (POS) equal to what it would have been had the service been provided in-person. We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. In certain cases, yes. Your access portal for updated claims and reports is secured via our HTTPS/SSL/TLS secured server. Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF). PT/OT/ST providers could deliver virtual care for any service that was on their fee schedule for dates of service through December 31, 2020. Cost-share will be waived only when providers bill the appropriate ICD-10 code (U07.1, J12.82, M35.81, or M35.89). When specific contracted rates are in place for diagnostic COVID-19 lab tests, Cigna will reimburse covered services at those contracted rates. Secure .gov websites use HTTPSA 31, 2022. lock Thanks for your help! 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. To this end, we appreciate the feedback and deep collaboration weve had with provider groups and medical societies regarding virtual care. Because most standard Cigna client benefit plans do not extend coverage to screening services when performed for employment reasons (e.g., occupational physical examination), virtual care screening services will generally not be covered solely for return-to-work purposes. On-demand virtual care for minor medical conditions, Talk therapy and psychiatry from the privacyof home. For dates of service February 4, 2020 through February 15, 2021, Cigna covered COVID-19 treatments without customer cost-share. Washington, D.C. 20201 For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. Unless telehealth requirements are . No additional modifiers are necessary. No. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. Similar to other providers and facilities, urgent care centers should bill just the appropriate COVID-19 vaccine administration code when that is the only service they are providing.Consistent with our reimbursement strategy for all other providers, urgent care centers will be reimbursed for covered vaccine administration services at contracted rates when specific contracted rates are in place for vaccine administration codes. Cigna covers C9803 with no customer cost-share for a hospital outpatient clinic visit specimen collection, including drive-thru tests, through at least May 11, 2023 only when billed without any other codes. Yes. 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.