Cigna Telehealth Place of Service Code: 02. Additional FDA EUA approved vaccines will be covered consistent with this guidance. 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. Cigna currently allows for the standard timely filing period plus an additional 365 days. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically For costs and details of coverage, review your plan documents or contact a Cigna representative. However, this added functionality is planned for a future update. A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders. https:// Please visit CignaforHCP.com/virtualcare for additional information about that policy. Home Visit Codes New Patient: 99343 Established Patient: 99349 Place of Service (POS): 12 - Home Office Visit Codes New Patient: 99203 Established Patient: 99213 Place of Service (POS): 11 - Office Telephone Call Codes Established Patient: 99442 Place of Service (POS): 11 - Office Modifiers GQ - Store-and-forward (asynchronous) Activate your myCigna account nowto get access to a virtual dentist. Are reasonable to be provided in a virtual setting; and, Are reimbursable per a providers contract; and, Use synchronous technology (i.e., audio and video) except 99441 - 99443, which are audio-only services, Urgent care centers to offer virtual care when billing with a global S9083 code, Most synchronous technology to be used (e.g., FaceTime, Skype, Zoom, etc. COVID-19 admissions would be emergent admissions and do not require prior authorizations. 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). On-demand virtual care for minor medical conditions, Talk therapy and psychiatry from the privacyof home. Cigna commercial and Cigna Medicare Advantage will waive the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. These resources offer access to live-guided relaxation sessions, wellness podcasts, and wellness and stress management flyers. Update to the telehealth Place of Service (POS) code Telehealth continues to be an integral part of providing safe and convenient health care visits for Medicare Advantage beneficiaries. An official website of the United States government. If the telephone, Internet, or electronic health record consultation leads to a transfer of care or other face-to-face service (e.g., a surgery, a hospital visit, or a scheduled office evaluation of the patient) within the next 14 days or next available appointment date of the consultant, these codes should not be billed. Non-contracted providers should use the Place of Service code they would have used had the . When billing, you must use the most appropriate code as of the effective date of the submission. 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. Similar to other providers and facilities, urgent care centers should bill just the appropriate COVID-19 vaccine administration code when that is the only service they are providing.Consistent with our reimbursement strategy for all other providers, urgent care centers will be reimbursed for covered vaccine administration services at contracted rates when specific contracted rates are in place for vaccine administration codes. Providers receive reasonable reimbursement consistent with national CMS rates for administering EUA-approved COVID-19 vaccines. 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. POS codes are two-digit codes reported on . Modifier 95, GT, or GQ must be appended to the virtual care code(s). Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. While we encourage PT/OT/ST providers to follow CMS guidance regarding the use of software programs for virtual care, we are not requiring the use of any specific software program at this time. For telehealth, the 95 modifier code is used as well. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. The following Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes are used to bill for telebehavioral and telemental health services and have been codified into the current Medicare Physician Fee Schedule (PFS). 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. These codes should be used on professional claims to specify the entity where service (s) were rendered. A short term accommodation such as a hotel, camp ground, hostel, cruise ship or resort where the patient receives care, and which is not identified by any other POS code. MLN Matters article MM12427, New modifications to place of service (POS) codes for telehealth. At a minimum, we will always follow Centers for Medicare & Medicaid Services (CMS) telehealth or state-specific requirements that apply to telehealth coverage for our insurance products. Place of Service 02 will reimburse at traditional telehealth rates. No additional credentialing or notification to Cigna is required. MLN Matters article MM12549, CY2022 telehealth update Medicare physician fee schedule. Once completed, telehealth will be added to your Cigna specialty. A facility, other than a hospital's maternity facilities or a physician's office, which provides a setting for labor, delivery, and immediate post-partum care as well as immediate care of new born infants. Reimbursement for codes that are typically billed include: Yes. Informing Cigna prior to delivering services in other states can help to ensure claims are adjudicated correctly when submitted with addresses in states other than the provider's usual location. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). (This code is available for use immediately with a final effective date of May 1, 2010), A location, not described by any other POS code, owned or operated by a public or private entity where the patient is employed, and where a health professional provides on-going or episodic occupational medical, therapeutic or rehabilitative services to the individual. No. Location, other than a hospital or other facility, where the patient receives care in a private residence. Cigna will 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, EEG or EKG testing). Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours. If a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. You'll always be able to get in touch. Providers should bill one of the above codes, along with: No. Intake / Evaluation (90791) Billing Guide, Evaluation with Medical Assessment (90792). All synchronous technology used must be secure and meet or exceed federal and state privacy requirements. Hi Laelia, I'd be happy to help. eConsult services remain covered; however, customer cost-share applies as of January 1, 2022. Service performed: OEce or other outpatient visit for the evaluation and management of a new patient CPT code billed: 99202 Modier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): 100% of face-to-face rate Customer cost-share: Applies consistent with These include: Virtual preventive care, routine care, and specialist referrals. 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). Urgent care centers can bill their global S code when a significant and separately identifiable service is performed at the same time as the administration of the vaccine, but will only be reimbursed for both services when their contract allows it (similar to how they may be reimbursed today for flu shot administration). We are awaiting further billing instructions for providers, as applicable, from CMS. Cigna continues to require prior authorization reviews for routine advanced imaging. Cigna offers a number of virtual care options depending on your plan. UnitedHealthcare (UHC) is now requiring physicians to bill eligible telehealth services with place of service (POS) 02 for commercial products. 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. Providers can check the Clear Claim ConnectionTM tool on CignaforHCP.com to determine if both the E&M and vaccine administration are allowed for the specific service the provider rendered. Below is a definition of POS 02 and POS 10 for CMS-1500 forms, alongside a list of major insurance brands and their changes. You can decide how often to receive updates. The site is secure. Bill those services on a CMS-1500 form or electronic equivalent. Yes. Place of Service 02 in Field 24-B (see sample claim form below) For illustrative purposes only. For other laboratory tests when COVID-19 may be suspected. Effective January 1, 2021, we implemented a new. Yes. A medical facility operated by one or more of the Uniformed Services. First Page. However, Cigna will still consider requestes for accelerated credentialing on a case-by-case basis. Yes. Cigna did not make any requirements regarding the type of technology used for virtual care through December 31, 2020 (i.e., phone, video, FaceTime, Skype, etc. 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. Intermediate Care Facility/ Individuals with Intellectual Disabilities. Organizations that offer Administrative Services Only (ASO) plans will be opted in to waiving cost-share for this service as well. A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services rendered by, or under the supervision of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients. Listed below are place of service codes and descriptions. Cost-share will be waived only when providers bill the appropriate ICD-10 code (U07.1, J12.82, M35.81, or M35.89). Ultimately however, care must be medically necessary to be covered. 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. were all appropriate to use through December 31, 2020. Your access portal for updated claims and reports is secured via our HTTPS/SSL/TLS secured server. A federal government website managed by the 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. The Virtual Care Reimbursement Policy also applies to non-participating providers. 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. While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. No authorization is required for the procurement or administration of COVID-19 infusion treatments. 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. This coverage began January 15, 2022 and continues through at least the end of the public health emergency (PHE) period (May 11, 2023). Claims were not denied due to lack of referrals for these services during that time. 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, we will reimburse this code at $22.99 consistent with CMS pricing to ensure consistent, timely, and reasonable reimbursement. Yes. No. Therefore, effective with August 15 dates of service, Cigna will reimburse providers consistent with CMS rates for doses of bebtelovimab that they purchase directly from the manufacturer. Audio -only CPT codes 98966 98968 and 99441 For providers whose contracts utilize a different reimbursement It remains expected that the service billed is reasonable to be provided in a virtual setting. For all other IFP plans outside of Illinois, primary care physicians are still encouraged to coordinate care and assist in locating in-network specialists, but the plans no longer have referral requirements as of January 1, 2021. Store and forward communications (e.g., email or fax communications) are not reimbursable. No. Residential Substance Abuse Treatment Facility. To this end, we will use all feedback we receive to consider further updates to our policy. 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. Paid per contract; standard cost-share applies. To help remove any barriers to receive testing, Cigna will cover any diagnostic molecular or antigen diagnostic test for COVID-19, including rapid tests and saliva-based tests, through at least May 11, 2023. Per CMS, individuals without health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost. All health insurance policies and health benefit plans contain exclusions and limitations. 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 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. As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. All Cigna Customers will pay $0 ingredient cost while funded by government, while Cigna commercial customers will pay up to a $6 dispensing fee when obtained at a pharmacy where the medications are available. eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. 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. website belongs to an official government organization in the United States. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. (This code is available for use effective January 1, 2013 but no later than May 1, 2013), A portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. Yes. 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 . Let us handle handle your insurance billing so you can focus on your practice. A residence, with shared living areas, where clients receive supervision and other services such as social and/or behavioral services, custodial service, and minimal services (e.g., medication administration). The change in the telehealth policy will take effect on January 1, 2022, and be implemented on April 4, 2022. (99441, 98966, 99442, 98967, 99334, 98968). As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of North Carolina, Inc. and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates ( see Cigna understands the tremendous pressure our healthcare delivery systems are under. Here is a complete list of place of service codes: Place of Service Codes. We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information. M0222 (administration in facility setting): $350.50, M0223 (administration in home setting): $550.50. Yes. 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. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. Yes. Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. 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. 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. When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9. Yes. They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. The patient may be either a new patient to the consultant or an established patient with a new problem or an exacerbation of an existing problem. Urgent care centers can also bill their typical S9083 code for services that are more complex than a quick telephone call. There are two primary types of tests for COVID-19: A serology (i.e., antibody) test for COVID-19 is considered diagnostic and covered without cost-share through at least May 11, 2023 when ALL of the following criteria are met: When specific contracted rates are in place for diagnostic COVID-19 serology tests, Cigna will reimburse covered services at those contracted rates. 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. Last updated February 15, 2023 - Highlighted text indicates updates. Yes. Secure .gov websites use HTTPSA The Department may not cite, use, or rely on any guidance that is not posted Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. Official websites use .govA Cigna covers FDA EUA-approved laboratory tests. This new initiative enables payment from original Medicare for submitted claims directly to participating eligible pharmacies and other health care providers, which allows Medicare beneficiaries to receive tests at no cost. (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.). Cigna does not require prior authorization for home health services. We are committed to helping providers deliver care how, when, and where it best meets the needs of their patients. As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. 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 who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. .gov We also continue to make several other accommodations related to virtual care until further notice. Yes. 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 For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. Note that billing B97.29 will not waive cost-share. Cigna covers Remdesivir for the treatment of COVID-19 when administered in inpatient or outpatient settings consistent with EUA usage guidelines and Cigna's Drug and Biologic Coverage Policy. Telehealth (also referred to as telemedicine) gives our members access to their health care provider from their home or another location. 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). Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. Yes. This code will only be covered where state mandates require it. To speak with a dentist,log in to myCigna. As of April 1, 2021, Cigna resumed standard authorization requirements. As always, we remain committed to ensuring that: Yes. Patient is not located in their home when receiving health services or health related services through telecommunication technology. 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. Mid-level practitioners (e.g., physician assistants and nurse practitioners) can also provide services virtually using the same guidance. We recommend providers bill POS 02 beginning July 1, 2022 for virtual services (instead of a face-to-face POS). No. This guidance applies to all providers, including laboratories. 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. As the government is providing the initial vaccine doses free of charge to health care providers, Cigna will not reimburse providers for the cost of the vaccine itself. (Effective January 1, 2003). A facility other than a hospital, which provides dialysis treatment, maintenance, and/or training to patients or caregivers on an ambulatory or home-care basis. Share sensitive information only on official, secure websites. 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. A facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters). Yes. Hospitals are still required to make their best efforts to notify Cigna of hospital admissions in part to assist with discharge planning. 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. 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. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. 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. Cigna will determine coverage for each test based on the specific code(s) the provider bills. When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance. 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. This policy applied to customers in the United States who are covered under Cigna's employer/union sponsored insured group health plans, insured plans for US-based globally mobile individuals, Medicare Advantage, and Individual and Family Plans (IFP). All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. In all cases, reimbursement will only be provided for hospital outpatient services performed in a clinic setting (including drive-thru testing sites) when billed on a UB-04 claim form with an appropriate revenue code.