Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. The Department may not cite, use, or rely on any guidance that is not posted for services delivered via telehealth. 2 Limited to labs contracted with MDLIVE for virtual wellness screenings. 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. Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. Certain PT, OT, and ST virtual care services remain reimbursable under the R31 Virtual Care Reimbursement Policy. When no specific contracted rates are in place, Cigna will reimburse covered services at the established national CMS rates to ensure timely, consistent, and reasonable reimbursement. Emotional health resources have been added to the COVID-19 interim guidance page for behavioral providers at CignaforHCP.com. If an urgent care center 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. Cigna will allow direct emergent or urgent transfers from an acute inpatient facility to a second acute inpatient facility, skilled nursing facility (SNF), acute rehabilitation facility (AR), or long-term acute care hospital (LTACH). For the R31 Virtual Care Reimbursement Policy, effective January 1, 2021, we continue to not make any requirements regarding the type of synchronous technology used until further notice. Yes. A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. Unless telehealth requirements are . While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. Outpatient E&M codes for new and established patients (99202-99215) Physical and occupational therapy E&M codes (97161-97168) Telephone-only E&M codes (99441-99443) Annual wellness visit codes (G0438 and G0439) For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. We will continue to monitor inpatient stays. 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 . 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. Add in the unnecessarily difficult insurance billing system and we run the risk of working way over full-time. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. Cigna follows CMS rules related to the use of modifiers. For example, if the Outbreak Period ends March 1, 2023, any service performed on or before that date will have its standard timely filing window begin upon the expiration of the Outbreak Period (here, March 1, 2023). 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. 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). Summary of Codes for Use During State of Emergency. over a 7-day period. Product availability may vary by location and plan type and is subject to change. 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. Certain home health services can be provided virtually using synchronous communication as part of our R31 Virtual Care Reimbursement Policy. 5 Virtual dermatological visits through MDLIVE are completed via asynchronous messaging. POS 02: Telehealth Provided Other than in Patient's Home 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. No. Providers should bill this code for dates of service on or after December 23, 2021. We are actively reviewing all COVID-19 state mandates and will continue to share any changes and more details around coverage, reimbursement, and cost-share as applicable. This includes providers who typically deliver services in a facility setting. (Effective January 1, 2016). Comprehensive Outpatient Rehabilitation Facility. Providers should append the GQ, GT, or 95 modifier and Cigna will reimburse them consistent with their face-to-face rates. 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. After the emergency use authorization (EUA) or licensure of each COVID-19 vaccine product by the FDA, CMS will identify the specific vaccine code(s) along with the specific administration code(s) for each vaccine that should be billed. All other customers will have the same cost-share as if they received the services in-person from that same provider. What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? Official websites use .govA Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. You want to get paid quickly, in full, and not have to do more than spend 10 or 15 minutes to input your weekly calendar. A facility which primarily provides health-related care and services above the level of custodial care to individuals but does not provide the level of care or treatment available in a hospital or SNF. The codes may only be billed once in a seven day time period. Per usual protocol, emergency and inpatient imaging services do not require prior authorization. Yes. Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.). When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9. Issued by: Centers for Medicare & Medicaid Services (CMS). 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. Yes. Cigna offers a number of virtual care options depending on your plan. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. Additional FDA EUA approved vaccines will be covered consistent with this guidance. Specimen collection will only be reimbursed in addition to other services when it is billed by an independent laboratory for travel to a skilled nursing facility (place of service 31), nursing home facility (place of service 32), or to an individuals home (place of service 12) to collect the specimen. (Description change effective January 1, 2016). Yes. For example, if a patient presents at an emergency room with a suspected broken ankle after a fall and is also tested for COVID-19 during the visit, Cigna would cover services related to treating the ankle at standard customer cost-share, while the COVID-19 laboratory test would be covered at no customer cost-share. And as your patients seek more convenient and safe care options, we continue to see growing interest in virtual care (i.e., telehealth) especially from consumers and their providers who want to ensure they have greater access and connection to each other. Washington, D.C. 20201 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. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. Cigna Telehealth Service is a one-stop mobile app for having virtual consultation with doctors in Hong Kong as well as getting Covid-19 self-test kit & medication delivered to your doorstep. Yes. Location, other than a hospital or other facility, where the patient receives care in a private residence. Modifier CS for COVID-19 related treatment. 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. 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. Antibody tests: 86328, 86769, 86408, 86409, 86413, and 0224U, Cigna covers diagnostic molecular and antigen tests for COVID-19 through at least. These codes should be used on professional claims to specify the entity where service (s) were rendered. 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. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. A facility or location whose primary purpose is to provide temporary housing to homeless individuals (e.g., emergency shelters, individual or family shelters). 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. Other Reimbursement Type. If the individual COVID-19 related diagnostic test(s) are included in a laboratory panel code, only the code for the panel test will be reimbursed. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Yes. New and revised codes are added to the CPBs as they are updated. For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. Billing an evaluation and management (E/M) code when that level of service is not provided is fraudulent billing and is expressly prohibited. 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. It must be initiated by the patient and not a prior scheduled visit. 1995-2020 by the American Academy of Orthopaedic Surgeons. Our data is encrypted and backed up to HIPAA compliant standards. This code will only be covered where state mandates require it. ), but the patient is also tested for COVID-19 for diagnostic reasons, the provider should bill the diagnosis code specific to the primary reason for the encounter in the first position, and the COVID-19 diagnosis code in any position after the first. You get connected quickly. 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. An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. 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. As of February 16, 2021 dates of service, cost-share applies. For COVID-19 related screening (i.e., quick phone or video consult): No cost-share for customers through at least, For non-COVID-19 related services (e.g., oncology visit, routine follow-up care): Standard customer cost-share. For telehealth, the 95 modifier code is used as well. Reimbursement for codes that are typically billed include: Yes. Please note that our interim COVID-19 virtual care guidelines were in place until December 31, 2020. In addition, the discharging provider or primary care physician can provide the post discharge visit virtually if appropriate. Listed below are place of service codes and descriptions. We did not make any requirements regarding the type of technology used. The Administration's plan is to end the COVID-19 public health emergency (PHE) on May 11, 2023. Telephone, Internet, or electronic health record consultations of less than five minutes should not be billed. 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. Maybe. At this time, providers who offer virtual care will not be specially designated within our public provider directories. This includes: Please refer to the interim COVID-19 virtual care guidelines for a complete outline of our interim COVID-19 virtual care coverage. This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. For more information, please visit Cigna.com/Coronavirus. No. Denny and his team are responsive, incredibly easy to work with, and know their stuff. What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? Store and forward communications (e.g., email or fax communications) are not reimbursable. Cigna covered the administration and post-administration monitoring of EUA-approved COVID-19 infusion treatments with no customer-cost share for services provided through February 15, 2021. Depending on your plan and location, you can connect with board-certified medical providers, dentists, and licensed therapists online using a phone, tablet, or computer. 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. 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. If a provider was reimbursed for a face-to-face service per their existing fee schedule, then they were reimbursed the same amount even if they delivered the service virtually. No. Recent guidelines have recommended keeping the normal service facility that you are registered under in your CMS-1500. 1 At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. 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 When an order for home health services is clinically appropriate for telehealth services, the care will be offered through a virtual visit unless the order indicates that home health services must be in-person or the patient refuses the virtual visit. 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.