For covered virtual care services cost-share will apply as follows: No. codes and normal billing procedures. No. Services not related to COVID-19 will have standard customer cost-share. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. Providers that administer vaccinations to patients without health insurance or whose insurance does not provide coverage of vaccination administration fees, may be able to file a claim with the provider relief fund, but may not charge patients directly for any vaccine administration costs. were all appropriate to use). In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. It's convenient, not costly. Telehealth claims with any other POS will not be considered eligible for reimbursement. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. To speak with a dentist,log in to myCigna. For services included in our Virtual Care Reimbursement Policy, a number of general requirements must be met for Cigna to consider reimbursement for a virtual care 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. The Virtual Care Reimbursement Policy also applies to non-participating providers. For more information about current Evernorth Behavioral Health virtual care guidance, please visit CignaforHCP.com > Resources > Behavioral Resources > Doing Business with Cigna > COVID-19: Interim Guidance. 1 Location, distinct from a hospital emergency room, an office, or a clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention. 4 Due to state laws governing teledentistry, this service is not available to residents of Texas. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. Location, other than a hospital or other facility, where the patient receives care in a private residence. For additional information about our Virtual Care Reimbursement Policy, please review the policy, contact your provider representative, or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). More information about coronavirus waivers and flexibilities is available on . What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? In these cases, providers should bill their regular face-to-face codes that are on their fee schedule, and add the GQ, GT, or 95 modifier to indicate the services were performed virtually. Other place of service not identified above. 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. 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. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. 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. The codes may only be billed once in a seven day time period. Please review our R33 COVID-19 Interim Billing Guidelines policy for ICD-10 diagnosis code requirements to have cost-share waived for G2012. Unless telehealth requirements are . Denny has interviewed hundreds of mental health practitioners to better understand their struggles and solutions, all with the goal of making the professional side of behavioral health a little easier, faster, and less expensive. Residential Substance Abuse Treatment Facility. Please review the Virtual care services frequently asked questions section on this page for more information. As of June 1, 2021, these plans again require referrals. Note that high-throughput tests may only be run in a high-complexity laboratory; The laboratory or provider bills using the codes in our interim billing guidelines and. At this time, providers who offer virtual care will not be specially designated within our public provider directories. 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. Contracted providers cannot balance bill customers for non-reimbursable codes. 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. 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. 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. 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. 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. Prior authorization for treatment follows the same protocol as any other illness based on place of service and according to plan coverage. Modifier 95, indicating that you provided the service via telehealth. As a reminder, standard customer cost-share applies for non-COVID-19 related services. The site is secure. List the address of the physician for the telehealth visit on the CMS1500 claim. A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. 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. He co-founded a mental health insurance billing service for therapists called TheraThink in 2014 to specifically solve their insurance billing problems. For dates of service February 4, 2020 through February 15, 2021, Cigna covered COVID-19 treatments without customer cost-share. Cigna commercial and Cigna Medicare Advantage customers receive the COVID-19 vaccine with no out-of-pocket costs; and. New telehealth POS A new place of service (POS) code will go into effect Jan. 1, 2022, but Medicare doesn't plan on using it. 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. When no specific contracted rates are in place, providers will be reimbursed $40 per dose for general vaccine administration and an additional $35.50 per dose for administering it in a home setting for total reimbursement of $75.50 per vaccine dose. As of April 1, 2021, Cigna resumed standard authorization requirements. As of April 4, 2022, individuals with Medicare Part B and Medicare Advantage plans can get up to eight OTC tests per calendar month from participating pharmacies and health care providers for the duration of the COVID-19 public health emergency (PHE). Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. No. 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. Over the past several years and accelerated during COVID-19 we have collaborated with and sought feedback from many local and national medical societies, provider groups in our network, and key collaborative partners that have suggested certain codes and services that should be addressed in a virtual care reimbursement policy. Telephone, Internet, or electronic health record consultations of less than five minutes should not be billed. 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. We understand that it's important to actually be able to speak to someone about your billing. Yes. Patient is not located in their home when receiving health services or health related services through telecommunication technology. Telehealth services not billed with 02 will be denied by the payer. Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; For example, if the Outbreak Period ends March 1, 2023, any service performed on or before that date will have its standard timely filing window begin upon the expiration of the Outbreak Period (here, March 1, 2023). You free me to focus on the work I love!. 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. 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 services where COVID-19 is not the initial clinical presentation (e.g., appendectomy, labor and delivery, etc. Coverage reviews for appropriate levels of care and medical necessity will still apply. Talk to a licensed dentist via a video call, 24/7/365. 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. A medical facility operated by one or more of the Uniformed Services. For more information, see the resources along the right-hand side of the screen. Talk directly to board-certified providers 24/7 by video or phone for help with minor, non-life-threatening medical conditions1. Organizations that offer Administrative Services Only (ASO) plans will be opted in to waiving cost-share for this service as well. The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. However, Cigna will still consider requestes for accelerated credentialing on a case-by-case basis. 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. A facility, other than a patient's home, in which palliative and supportive care for terminally ill patients and their families are provided. 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). 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. Please note that this guidance applies to drive through testing as well, and includes services performed by a free-standing emergency room or any other provider. Yes. Yes. Yes. Usually not. While Cigna doesn't require further credentialing or license validation, and the provider can work under the scope of their license, providers are encouraged to inform Cigna when they will practice across state lines. Please note that some opt-outs for self-funded benefit plans may have applied. Yes. Share sensitive information only on official, secure websites. Urgent care centers can also bill their typical S9083 code for services that are more complex than a quick telephone call. In addition, Anthem would recognize telephonic-only . bill a typical face-to-face place of service (e.g., POS 11) . Considering the pressure facilities are under, Cigna will extend the authorization approval window from three months to six months on request. Non-residential Substance Abuse Treatment Facility, Non-residential Opioid Treatment Facility, A location that provides treatment for opioid use disorder on an ambulatory basis. 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. 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. Yes. 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. Further, we will continue to monitor virtual care health outcomes and claims data as well as provider, customer, and client feedback to ensure that our reimbursement and coverage strategy continues to meet the needs of those we serve. How Can You Tell Which Specific Technology is Reimbursable? 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. Billing an evaluation and management (E/M) code when that level of service is not provided is fraudulent billing and is expressly prohibited. Therefore, please refer to those guidelines for services rendered prior to January 1, 2021. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. 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. We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. Clarifying Codes G0463 and Q3014 Unfortunately, this policy also created a great deal of confusion and inconsistency among providers regarding which code to bill when providing remote clinic visits: G0463, Hospital outpatient clinic visit for assessment and management of a patient, or Q3014, Telehealth originating site facility fee. The ordering provider should use the standard, existing process to submit home health orders to eviCore healthcare. Cost-share will be waived for COVID-19 related services only when providers bill the appropriate ICD-10 code and modifier CS. No additional modifiers are necessary to include on the claim. Cigna has not lifted precertification requirements for scheduled surgeries. A location which provides treatment for substance (alcohol and drug) abuse on an ambulatory basis. 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). No virtual care modifier is needed given that the code defines the service as an eConsult. Place of Service 02 in Field 24-B (see sample claim form below) For illustrative purposes only. Telephone codes were added to the list of services that can be billed via telehealth, and the rates for codes 99441-99443 were increased, to match the rates for 99212-99214 Office visit codes must still use two-way audio and visual, real time interactive technologies, but the payment rates for audio only codes (99441-99443) were increased