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. Cigna will accept roster billing from providers who are already mass immunizers and bill Cigna today in this way for other vaccines (e.g., seasonal flu vaccine), as well as from providers and state agencies that are offering mass vaccinations for their local communities, provided the claim roster includes sufficient information to identify the Cigna customer. 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. Please note that while Cigna Medicare Advantage plans do fully cover the costs for COVID-19 tests done in a clinical setting, costs of at-home COVID-19 tests are not a covered benefit. Every provider we work with is assigned an admin as a point of contact. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. Patient is not located in their home when receiving health services or health related services through telecommunication technology. As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. Usually not. 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. 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. Our national ancillary partner American Specialty Health (ASH) is applying the same virtual care guidance, so any provider participating through ASH and providing PT/OT services to Cigna customers is covered by the same guidance. In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. (As of 01/21/2021) What Common Procedural Technology (CPT) codes should be used for COVID-19 testing? 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 may request the appropriate CLIA-certification or waiver as well as the manufacturer and name of the test being performed. All health insurance policies and health benefit plans contain exclusions and limitations. We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information. 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). More information about coronavirus waivers and flexibilities is available on . **, Watch this short video to learn more about virtual care with MDLivefor Cigna.(Length: 00:01:33). Yes. The change in the telehealth policy will take effect on January 1, 2022, and be implemented on April 4, 2022. You free me to focus on the work I love!. 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. Telehealth CPT codes 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (20-30 minutes) Reimbursements match similar in-person services, increasing from about $14-$41 to about $60-$137, retroactive to March 1, 2020 Previously, these codes were reimbursable as part of our interim COVID-19 accommodations. Preventive care checkups and wellness screenings available at no additional cost, Routine care visits allow you to build a relationship with the same primary care provider (PCP) to helpmanage conditions, Prescriptions available through home delivery orat local pharmacies, if appropriate, Receive orders for biometrics, blood work andscreenings at local facilities, Skin conditions such as rashes, moles, eczema, and psoriasis, Care for hundreds of minor medical conditions, A convenient and affordable alternative to urgent, Schedule an appointment that works for you, You have the option to select the same provider for every session, Get prescriptions sent directly to your local pharmacy, if appropriate. Cigna understands the tremendous pressure our healthcare delivery systems are under. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. No waiting rooms. 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. Reimbursement, when no specific contracted rates are in place, are as follows: No. Modifier CR and condition code DR can also be billed instead of CS. Please review the Virtual care services frequently asked questions section on this page for more information. It's our goal to ensure you simply don't have to spend unncessary time on your billing. The Virtual Care Reimbursement Policy also applies to non-participating providers. Specimen collection is not generally paid in addition to other services on the same date of service for the same patient whether billed on the same or different claims by the same provider. Considering the pressure facilities are under, Cigna will extend the authorization approval window from three months to six months on request. The location where health services and health related services are provided or received, through telecommunication technology. Certain client exceptions may apply to this guidance. Providers should bill one of the above codes, along with: No. (99441, 98966, 99442, 98967, 99334, 98968). 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. 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 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. When no specific contracted rates are in place, we will reimburse this code at $22.99 consistent with CMS pricing to ensure consistent, timely, and reasonable reimbursement. 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. Emergent transport to nearby facilities capable of treating customers is covered without prior authorization. Cigna does require prior authorization for fixed wing air ambulance transport. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. In these cases, the non-credentialed provider can bill under the group assuming they are practicing within state laws to administer the vaccine. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. bill a typical face-to-face place of service (e.g., POS 11) . 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. 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]). As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. In addition, the discharging provider or primary care physician can provide the post discharge visit virtually if appropriate. Services include physical therapy, occupational therapy, and speech pathology services. Routine and non-emergent transfers to a secondary facility continue to require authorization. that insure or administer group HMO, dental HMO, and other products or services in your state). 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. Last updated February 15, 2023 - Highlighted text indicates updates. 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. Deliver services that are covered by the Virtual Care Reimbursement Policy; Bill consistently with the requirements of the policy; and. 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. This is an extenuating circumstance. 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. It must be initiated by the patient and not a prior scheduled visit. for services delivered via telehealth. 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. 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. R33 COVID-19 Interim Billing Guidelines policy, COVID-19: In Vitro Diagnostic Testing coverage policy, COVID-19 In Vitro Diagnostic Testing coverage policy, Express Scripts discount prescription program, Centers for Medicare & Medicaid Services (CMS) COVID-19 vaccine resources, Cigna Coronavirus (COVID-19) Resource Center, 0001A, 0002A, 0003A, 0004A, 0011A, 0012A, 0013A, 0031A, 0034A, 0041A, 0042A, 0044A, 0051A, 0052A, 0053A, 0054A, 0064A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A, 0124A, 0134A, 0144A, 0154A, 0164A, 0173A, and M0201, Virtual screening telephone consult (5-10 minutes), Virtual or face-to-face visit for treatment of a, Drug and administration of infusion treatments for a confirmed COVID-19 case, M0220, M0221, M0222, M0223, M0240, M0241, M0243, M0244, M0245, M0246, M0247, M0248, M0249, Q0222, and M0250, COVID-19 laboratory testing (including PCR, antigen, and serology [i.e., antibody] tests), COVID-19 related diagnostic tests (other than COVID-19 test), Non COVID-19 virtual visit (i.e., telehealth), In-office or facility visit not related to COVID-19, Pfizer-BioNTech COVID-19 Vaccine Administration First Dose, Pfizer-BioNTech COVID-19 Vaccine Administration Second Dose, Pfizer-BioNTech COVID-19 Vaccine Administration Third Dose, Pfizer-BioNTech COVID-19 Vaccine Administration Booster, Moderna COVID-19 Vaccine Administration First Dose, Moderna COVID-19 Vaccine Administration Second Dose, Moderna COVID-19 Vaccine Administration Third Dose, Janssen COVID-19 Vaccine Administration Booster, Novavax COVID-19 Vaccine, Adjuvanted Administration First Dose, Novavax COVID-19 Vaccine, Adjuvanted Administration Second Dose, Novavax COVID-19 Vaccine, Adjuvanted Administration Booster, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - First dose, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Second dose, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Third dose, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Booster, Moderna COVID-19 Vaccine (Low Dose) Administration Booster, Pfizer-BioNTech COVID-19 Pediatric Vaccine Administration First dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine Administration Second dose, Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration Third dose, Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration Booster, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration First dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration Second dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration Third dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration First dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration Second dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration Third dose, Moderna COVID-19 Vaccine (Blue Cap) 50MCG/0.5ML Administration Booster, Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration First dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration Second dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration Third dose, Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Gray Cap) Administration Booster Dose, Moderna COVID-19 Vaccine, Bivalent (Aged 18 years and older) (Dark Blue Cap with gray border) Administration Booster Dose, Moderna COVID-19 Vaccine, Bivalent (Aged 6 years through 11 years) (Dark Blue Cap with gray border) Administration Booster Dose, Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 5 years through 11 years) (Orange Cap) Administration Booster Dose, Moderna COVID-19 Vaccine, Bivalent (Aged 6 months through 5 years) (Dark Pink Cap and label with a yellow box) Administration Booster Dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration Third dose, The initial COVID-19 diagnostic service (virtually, in an office, or at an emergency room, urgent care center, drive thru specimen collection center, or other facility), Specimen collection by a health care provider, Laboratory test (performed by state, hospital, or commercial laboratory; or other provider), Treatment (treatments that Cigna will cover for COVID-19 are those covered under Medicare or other applicable state regulations). Primary care physician to specialist requesting input from a cardiologist, psychiatrist, pulmonologist, allergist, dermatologist, surgeon, oncologist, etc. BCBSNC Telehealth Corporate Reimbursement Policy CIGNA Humana Humana Telehealth Expansion 03/23/2020 Humana provider FAQs Medicaid Special Bulletin #28 03/30/2020 (Supersedes Special Bulletin #9) Medicare Telemedicine Provider Fact Sheet 03/17/2020 Medicare Waivers 03.30.2020 PalmettoGBA MLN Connects Special Edition - Tuesday, March 31, 2020 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.). A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Before sharing sensitive information, make sure youre on a federal government site. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). 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. We will also closely monitor and audit claims for inappropriate services that should not be performed virtually (including but not limited to: acupuncture, all surgical codes, anesthesia, radiology services, laboratory testing, administration of drugs and biologics, infusions or vaccines, and EEG or EKG testing). Under My Account > Settings > Practice Details, you can select the Insurance Place of Service code associated with sessions held via video. The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. Thanks for your help! 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 . No additional modifiers are necessary to include on the claim. As private practitioners, our clinical work alone is full-time. were all appropriate to use). Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. Yes. Please note that certain client exceptions may apply (e.g., clients may opt out of the treatment cost-share waiver or opt-in for an extension of the cost-share waiver). Yes. As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. POS 11, 19 and 22) modifier GT or 95 (or GQ for Medicaid) must be used. Providers will not need a specific consent from patients to conduct eConsults. Yes. Ultimately however, care must be medically necessary to be covered. For other laboratory tests when COVID-19 may be suspected. New/Modifications to the Place of Service (POS) Codes for Telehealth. No. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. 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. U.S. Department of Health & Human Services 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. 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. 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). As always, we remain committed to providing further updates as soon as they become available. Providers receive reasonable reimbursement consistent with national CMS rates for administering EUA-approved COVID-19 vaccines. A provider should bill on the same form they usually do (e.g., CMS 1500 or UB-04) as when they provide the service face-to-face. Specimen collection centers like these can also bill codes G2023 or G2024 following the preceding guidance. ICD-10 code U07.1, J12.82, M35.81, or M35.89. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). 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 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. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. However, providers are required to attest that their designated specialty meets the requirements of Cigna. No. Inflammation, sores or infection of the gums, and oral tissues, Guidance on whether to seek immediate emergency care, Board-certified dermatologists review pictures and symptoms; prescriptions available, if appropriate, Care for common skin, hair and nail conditions including acne, eczema, psoriasis, rosacea, suspicious spots, and more, Diagnosis and customized treatment plan, usually within 24 hours. Store and forward communications (e.g., email or fax communications) are not reimbursable. The provider will need to code appropriately to indicate COVID-19 related services. No. For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. As of February 16, 2021 dates of service, cost-share applies. All other customers will have the same cost-share as if they received the services in-person from that same provider. 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 or distinct part of a facility for psychiatric care which provides a total 24-hour therapeutically planned and professionally staffed group living and learning environment. 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.

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