Certain PT, OT, and ST virtual care services remain reimbursable under the R31 Virtual Care Reimbursement Policy. When specific contracted rates are in place for COVID-19 specimen collection services, Cigna will reimburse covered services at those contracted rates. 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. 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. You can call, text, or email us about any claim, anytime, and hear back that day. Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. Contracted providers cannot balance bill customers for non-reimbursable codes. Maybe. Providers that receive the COVID-19 vaccine free of charge from the federal government are prohibited from seeking reimbursement from consumers for vaccine administration costs whether as cost sharing or balance billing. Claims were not denied due to lack of referrals for these services during that time. The location where health services and health related services are provided or received, through telecommunication technology. Standard customer cost-share applies. Please visit. The POS Workgroup is revising the description of POS code 02 and creating a new POS code 10 to meet the overall industry needs, as follows: 1. Therefore, your patients with Cigna commercial coverage can purchase OTC tests from a health care provider and seek reimbursement by billing Cigna directly following our published guidance. Telehealth (also referred to as telemedicine) gives our members access to their health care provider from their home or another location. 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. When billing, you must use the most appropriate code as of the effective date of the submission. 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. They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. 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. No. Yes. 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. However, facilities will not be penalized financially for failure to notify us of admissions. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. No. new codes. MVP will email or fax updates to providers and will update this page accordingly. What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? We do not expect smaller laboratories or doctors' offices to be able to perform these tests. Subscribe now with just HK$100. New/Modifications to the Place of Service (POS) Codes for Telehealth. We maintain all current medical necessity review criteria for virtual care at this time. 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). Locations may have included hospitals, rehabilitation centers, skilled nursing facilities, temporary hospitals, or any other facility where treatment is generally provided. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. Schedule an appointment online with MDLIVE and visit a lab for your blood work and biometrics. You can call, text, or email us about any claim, anytime, and hear back that day. 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. Excluded physician services may be billed An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. Audio-only encounters can be provided using the telephone evaluation and management codes (CPT codes. 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 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. 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. 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. Providers will continue to be reimbursed at 100% of their face-to-face rates for covered virtual care services, even when billing POS 02. Summary of Codes for Use During State of Emergency. Yes. Add in the unnecessarily difficult insurance billing system and we run the risk of working way over full-time. The provider will need to code appropriately to indicate COVID-19 related services. 1 Our mental health insurance billing staff is on call Monday Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy. Telehealth services not billed with 02 will be denied by the payer. Under My Account > Settings > Practice Details, you can select the Insurance Place of Service code associated with sessions held via video. 4 Due to state laws governing teledentistry, this service is not available to residents of Texas. As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. Other Reimbursement Type. We added a number of additional codes in March and April 2022 that are now eiligible for reimbursement. 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. Yes. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other . In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. For the immediate future, we will continue to reimburse virtual care services consistent with face-to-face rates. For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. There may be limited exclusions based on the diagnoses submitted. Specimen collection centers like these can also bill codes G2023 or G2024 following the preceding guidance. Please visit. 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. Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (LINA) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (NYLGICNY) (New York, NY), formerly known as Cigna Life Insurance Company of New York. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. Please review the "Virtual care services" frequently asked questions section on this page for more information. To sign up for updates or to access your subscriber preferences, please enter your contact information below. Please note, however, that we consider a providers failure to request an authorization due to COVID-19 an extenuating circumstance in the same way we view care provided during or immediately following a natural catastrophe (e.g., hurricane, tornado, fires, etc.). Additionally, Cigna understands the tremendous pressure our health care delivery systems are under and will factor in the current strain on health care systems and incorporate this information into retrospective coverage reviews. No virtual care modifier is needed given that the code defines the service as an eConsult. For dates of service April 14, 2020 through at least May 11, 2023, Cigna will cover U0003 and U0004 with no customer cost-share when billed by laboratories using high-throughput technologies as described by CMS. For dates of service February 4, 2020 through February 15, 2021, Cigna covered COVID-19 treatments without customer cost-share. To receive payment equivalent to a normal face-to-face visit you will not bill POS 2 and instead will follow Medicare guidance to bill POS 11 as if care was delivered in the office during COVID-19. 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. Prior authorization for treatment follows the same protocol as any other illness based on place of service and according to plan coverage. Yes. Please note that Cigna temporarily increased the precertification approval window for all elective inpatient and outpatient services - including advanced imaging - from three months to six months for dates of authorization beginning March 25, 2020 through March 31, 2021. MLN Matters article MM12549, CY2022 telehealth update Medicare physician fee schedule. However, Cigna will still consider requestes for accelerated credentialing on a case-by-case basis. Cigna has not lifted precertification requirements for scheduled surgeries. As of July 1, 2022, we request that providers bill with POS 02 for all virtual care. For dates of service April 1 - June 30, 2022, Cigna will apply a 1% payment adjustment. Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. Cigna will waive all customer cost-share for diagnostic services, testing, and treatment related to COVID-19, as follows: The visit will be covered without customer cost-share if the provider determines that the visit was consistent with COVID-19 diagnostic purposes. 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. A facility, other than a patient's home, in which palliative and supportive care for terminally ill patients and their families are provided. Important notes, What the accepting facility should know and do. A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. 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. 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.