Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. When no specific contracted rates are in place, Cigna will reimburse the administration of all emergency use authorized (EUA) vaccines at the established national, Cigna will reimburse vaccinations administered in a home setting an additional $35.50 per dose consistent with the established national. ) However, providers are required to attest that their designated specialty meets the requirements of Cigna. While we will reimburse these services consistent with face-to-face rates, we will monitor the use of level four and five services to limit fraud, waste, and abuse. Listed below are place of service codes and descriptions. Residential Substance Abuse Treatment Facility. Place of Service 02 in Field 24-B (see sample claim form below) For illustrative purposes only. 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). 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. Cigna commercial and Cigna Medicare Advantage customers receive the COVID-19 vaccine with no out-of-pocket costs; and. Most mental health providers will be furnishing services using Place of Service code 10 (POS 10) when providing telehealth services. No waiting rooms. Services include physical therapy, occupational therapy, and speech pathology services. Listed below are place of service codes and descriptions. Reimbursement, when no specific contracted rates are in place, are as follows: No. Approximately 98% of reviews are completed within two business days of submission. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. Certain client exceptions may apply to this guidance. Yes. This will help with tracking purposes, and ensure timely reimbursement for the administration of the treatment. bill a typical face-to-face place of service (e.g., POS 11) . 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. Locations may have included hospitals, rehabilitation centers, skilled nursing facilities, temporary hospitals, or any other facility where treatment is generally provided. POS 10 Telehealth provided in a patient's home was created for services provided remotely to a patient in their private residence. Cigna has not lifted precertification requirements for scheduled surgeries. Cigna allows modifiers GQ, GT, or 95 to indicate virtual care for all services. Medicare telehealth services practitioners use "02" if the telehealth service is delivered anywhere except for the patient's home. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. 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. Reimbursement will be consistent as though they performed the service in a face-to-face setting. Cigna may not control the content or links of non-Cigna websites. 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. For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. While Cigna does not require any specific placement for COVID-19 diagnosis codes on a claim, we recommend providers include the COVID-19 diagnosis code for confirmed or suspected COVID-19 patients in the first position when the primary reason the patient is treated is to determine the presence of COVID-19. In these cases, the urgent care center should append a GQ, GT, or 95 modifier, and we will reimburse the full face-to-face rate for insured and Non-ERISA ASO customers in states where telehealth parity laws exist. 3. 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. The Outbreak Period is a period distinct from the COVID-19 public health emergency (PHE), which applies to other COVID-related relief measures, such as no-cost share coverage of COVID-19 testing. Yes. Area (s) of Interest: Payor Issues and Reimbursement. No additional modifiers are necessary to include on the claim. Yes. It depends upon the clients benefit plan, but as noted above, testing is usually not covered for these purposed because most standard Cigna client benefit plans do not cover non-diagnostic tests for these non-diagnostic reasons. First Page. 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. State and federal mandates, as well as customer benefit plan designs, may supersede our guidelines. 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. Please visit. A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician. Urgent care centers can also bill their typical S9083 code for services that are more complex than a quick telephone call. Cigna will reimburse Remdesivir for COVID-19 treatment when administered in inpatient or outpatient settings at the national CMS reimbursement rate (or average wholesale pricing [AWP] if a CMS rate is not available) when the drug costs are not included in case rates or per diems to ensure timely, consistent, and reasonable reimbursement. 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. When billing for telehealth, it's unclear what place of service code to use. Cost-share will be waived only when providers bill the appropriate ICD-10 code (U07.1, J12.82, M35.81, or M35.89). No authorization is required for the procurement or administration of COVID-19 infusion treatments. Once completed, telehealth will be added to your Cigna specialty. 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). Cigna remains adequately staffed to respond to all new precertification requests for elective procedures within our typical timelines. A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. This is true for Medicare or other insurance carriers. What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? For all Optum Behavioral Health commercial plans, any telehealth services provided via a real-time audio and video communication system can be billed for members at home or another location. Modifier 95, GT, or GQ must be appended to the virtual care code(s). The ICD-10 codes for the reason of the encounter should be billed in the primary position. When specific contracted rates are in place for COVID-19 vaccine administration services, Cigna will reimburse covered services at those contracted rates. The codes may only be billed once in a seven day time period. 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. Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. 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. POS 02: Telehealth Provided Other than in Patient's Home When providers purchase the drug itself from the manufacturer (e.g., bebtelovimab billed with Q0222), Cigna will reimburse the cost of the drug when covered. Effective for dates of service on and after March 2, 2020 until further notice, Cigna will cover eConsults when billed with codes 99446-99449, 99451 and 99452 for all conditions. We also continue to make several other accommodations related to virtual care until further notice. Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. 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. 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. Organizations that offer Administrative Services Only (ASO) plans will be opted in to waiving cost-share for this service as well. 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). Please know that we 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. CPT 99490 covers at least 20 minutes of non-face-to-face chronic care management services provided by clinical staff. Cigna will not make any requirements as it relates to virtual services being for a new or existing patient. 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. The Virtual Care Reimbursement Policy also applies to non-participating providers. As always, we remain committed to ensuring that: Yes. 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. No. Modifier 95, GT, or GQ must be appended to the appropriate CPT or HCPCS procedure code(s) to indicate the service was for virtual care. 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. Cigna will factor in the current strain on health care systems and will incorporate this information into retrospective reviews. 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. Yes. We will also continue to consider Centers for Medicare & Medicaid (CMS) guidance, industry standards, and affordability for our clients to help inform any potential future changes to our reimbursement approach. No. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). 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. As of July 1, 2022, standard credentialing timelines again apply. 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). Recently, the Centers for Medicare & Medicaid Services (CMS) introduced a new place-of-service (POS) code and revised another POS code in an effort to improve the reporting of telehealth services provided to patients at home as well as the coverage of telebehavioral health. NOTE: As of March 2020, Cigna has waived their attestation requirements however we always recommend calling Cigna or any insurance company to complete an eligibility and benefits verification to ensure your telehealth claims will process through to completion. 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. Non-contracted providers should use the Place of Service code they would have used had the . My daily insurance billing time now is less than five minutes for a full day of appointments. For telehealth services rendered by a facility provider, report the CPT/HCPCS code with the applicable revenue code as would normally be done for an in-person visit, and also append either modifier 95 or GT. 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. 31, 2022. An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. Cigna covers FDA EUA-approved laboratory tests. Instead U07.1, J12.82, M35.81, or M35.89 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnoses.Please refer to the general billing guidance for additional information. For details, see the CMS document titled Place of Service Codes for Professional Claims Database (updated September 2021). Yes. 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. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. For dates of service February 4, 2020 through February 15, 2021, Cigna covered COVID-19 treatments without customer cost-share. 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). Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. 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. A facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on a 24-hour basis, by or under the supervision of a physician. Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. TheraThink provides an affordable and incredibly easy solution. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board. Cigna will determine coverage for each test based on the specific code(s) the provider bills. This eases coordination of benefits and gives other payers the setting information they need. 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. In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. To speak with a dentist,log in to myCigna. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 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. Store and forward communications (e.g., email or fax communications) are not reimbursable. No. Audio-only encounters can be provided using the telephone evaluation and management codes (CPT codes. Cigna continues to require prior authorization reviews for routine advanced imaging. You can call, text, or email us about any claim, anytime, and hear back that day. Telephone, Internet, or electronic health record consultations of less than five minutes should not be billed. 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. Codes on the list of approved telehealth services allow for various settings, but there must be both audio and video in real time between the physician . As of February 16, 2021 dates of service, cost-share applies. Services performed on and after March 1, 2023 would have just their standard timely filing window. Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. As of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. Schedule an appointment online with MDLIVE and visit a lab for your blood work and biometrics. 1. The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place at least until the end of Public Health Emergency (PHE) period.