As of June 1, 2021, these plans again require referrals. Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. When billing for the service, indicate the place of service as where the visit would have occurred if in person. 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. POS 02: Telehealth Provided Other than in Patient's Home We are your billing staff here to help. Place of Service 02 will reimburse at traditional telehealth rates. However, facilities will not be penalized financially for failure to notify us of admissions. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. Yes. No. When a state allows an emergent temporary provider licensure, Cigna will allow providers to practice in that state as participating if a provider is already participating with Cigna, is in "good standing," and if state regulations allow such care to take place. Cigna does not provide additional reimbursement for PPE-related costs, including supplies, materials, and additional staff time (e.g., CPT codes 99072 and S8301), as office visit (E&M) codes include overhead expenses, such as necessary PPE. and the home vaccine administration code (M0201) on the same claim under the medical benefit.When specific contracted rates are in place for vaccine administration services, Cigna will reimburse covered services at those contracted rates. website belongs to an official government organization in the United States. To this end, we appreciate the feedback and deep collaboration weve had with provider groups and medical societies regarding virtual care. POS 10 Telehealth provided in a patient's home was created for services provided remotely to a patient in their private residence. 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. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing. 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. Per usual policy, Cigna does not require three days of inpatient care prior to transfer to a SNF. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Certain client exceptions may apply to this guidance. This code will only be covered where state mandates require it. Cigna may request the appropriate CLIA-certification or waiver as well as the manufacturer and name of the test being performed. Cigna allows modifiers GQ, GT, or 95 to indicate virtual care for all services. No. An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. Yes. 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. A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician's office. PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. No. 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). 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. Services include methadone and other forms of Medication Assisted Treatment (MAT). For a complete list of billing requirements, please review the Virtual Care Reimbursement Policy. Secure .gov websites use HTTPSA Talk to board-certified dermatologists without an appointment for customized care for skin, hair, and nail conditions. Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. Patient is not located in their home when receiving health services or health related services through telecommunication technology. If antibodies are present, it means that individual previously had a specific viral or bacterial infection - like COVID-19. Providers billing under an 837P/1500 must include the place of service (POS) code 02 when submitting claims for services delivered via telehealth. 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). 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. You can call, text, or email us about any claim, anytime, and hear back that day. 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. Please note that state mandates and customer benefit plans may supersede our guidelines. Cigna Telehealth Place of Service Code: 02. My daily insurance billing time now is less than five minutes for a full day of appointments. that insure or administer group HMO, dental HMO, and other products or services in your state). Non-contracted providers should use the Place of Service code they would have used had the . 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). A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided. Must be performed by a licensed provider. Yes. Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. The Virtual Care Reimbursement Policy also applies to non-participating providers. Yes. 3 Biometric screening experience may vary by lab. When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). Additional FDA EUA approved vaccines will be covered consistent with this guidance. PT/OT/ST providers should continue to submit virtual claims with a GQ, GT, or 95 modifier and POS 02, and they will be reimbursed at their face-to-face rates. Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. 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). When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. Listed below are place of service codes and descriptions. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. The location where health services and health related services are provided or received, through telecommunication technology. 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. These codes should be used on professional claims to specify the entity where service(s) were rendered. 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). What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? Yes. Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours. You can call, text, or email us about any claim, anytime, and hear back that day. (Effective January 1, 2020). 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. The location where health services and health related services are provided or received, through telecommunication technology. COVID-19 admissions would be emergent admissions and do not require prior authorizations. A facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services by, or under, the supervision of physicians to patients admitted for a variety of medical conditions. 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. 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. Live-guided relaxation by telephone Available for all providers at no cost Every Tuesday at 5:00pm ET Call 866.205.5379, enter passcode 113 29 178, and then press # Additional Resources Cigna Medicare Billing guidelines and telehealth Cigna Dental Interim Communication to Providers QualCare Workers Compensation Interim billing guidance We are awaiting further billing instructions for providers, as applicable, from CMS. Once completed, telehealth will be added to your Cigna specialty. Generally, only well-equipped commercial laboratories and hospital-based laboratories will have the necessary equipment to offer these tests. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 5 Virtual dermatological visits through MDLIVE are completed via asynchronous messaging. 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. For virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02. Reimbursement for the administration of the injection will remain the same. No virtual care modifier is needed given that the code defines the service as an eConsult. ** The Benefits of Virtual Care No waiting rooms. As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. If specimen collection and a laboratory test are billed together, only the laboratory test will be reimbursed. Telehealth can provide many benefits for your practice and your patients, including increased Yes. It must be initiated by the patient and not a prior scheduled visit. Approximately 98% of reviews are completed within two business days of submission. Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF). 3. Talk directly to board-certified providers 24/7 by video or phone for help with minor, non-life-threatening medical conditions1. 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 covers diagnostic antibody tests when 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). Cigna will allow commercial and behavioral providers who are participating with Cigna (and who have up-to-date credentialing) to provide in-person or virtual care in other states to the extent that the scope of the license and state regulations allow such care to take place. As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. 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. 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. incorporated into a contract. 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. A freestanding facility, other than a physician's office, where surgical and diagnostic services are provided on an ambulatory basis. However, this added functionality is planned for a future update. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. Throughout the pandemic, the emergency use authorized monoclonal antibody drug bebtelovimab was purchased by the federal government and offered to providers for free. Intake / Evaluation (90791) Billing Guide, Evaluation with Medical Assessment (90792). For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. Providers administering the vaccine to individuals without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the Provider Relief Fund. 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]). U.S. Department of Health & Human Services Yes. Under My Account > Settings > Practice Details, you can select the Insurance Place of Service code associated with sessions held via video.