Psychiatric Facility-Partial Hospitalization. Therefore, as of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician's office. Routine and non-emergent transfers to a secondary facility continue to require authorization. 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 facility (place of service 32), or to an individuals home (place of service 12) to collect the specimen. Cigna offers a number of virtual care options depending on your plan. Providers can bill code G2012 for a quick 5-10 minute phone conversation as part of our R31 Virtual Care Reimbursement Policy, with cost-share waived through at least May 11, 2023 for customers when the conversation is related to COVID-19. Cigna Telehealth Place of Service Code: 02. Yes. If a provider typically delivered face-to-face services in a facility setting, that provider could also deliver any appropriate service virtually consistent with existing Cigna policies through December 31, 2020 dates of service. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. POS 10 Telehealth provided in a patient's home was created for services provided remotely to a patient in their private residence. Modifier 95, indicating that you provided the service via telehealth. No. M0222 (administration in facility setting): $350.50, M0223 (administration in home setting): $550.50. Yes. On January 1, 2021, we implemented a Virtual Care Reimbursement Policy that ensures permanent coverage of certain virtual care services. We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice. 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. More information about coronavirus waivers and flexibilities is available on . POS codes are two-digit codes reported on . Cost-share is waived when G2012 is billed for COVID-19 related services consistent with our, ICD-10 code Z03.818, Z11.52, Z20.822, or Z20.828, POS 02 and GQ, GT, or 95 modifier for virtual care. 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. Official websites use .govA No. Cigna continues to reimburse participating providers when they are credentialed to practice medicine per state regulations, have a current contract, and have completed the Cigna credentialing process.Non-participating providers will only be reimbursed if: Yes. 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 (whether billed on the same or different claims). 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. Inpatient COVID-19 care that began on or before February 15, 2021, and continued after February 16, 2021, will have cost-share waived for the entire course of the facility stay. (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.). 200 Independence Avenue, S.W. . To increase convenient 24/7 access to care if a patients preferred provider is unavailable in-person or virtually, our virtual care platform also offers solutions that include national virtual care vendors like MDLive. Neither U0003 nor U0004 should be used for tests that are used to detect COVID-19 antibodies. (99441, 98966, 99442, 98967, 99334, 98968). bill a typical face-to-face place of service (e.g., POS 11) . Cigna Telehealth Place of Service Code: 02 Cigna Telehealth CPT Code Modifier: 95 We charge a percentage of the allowed amount per paid claim (only paid claims) No per claim submission fee No annual or monthly subscription fee Cigna will determine coverage for each test based on the specific code(s) the provider bills. A certified facility which is located in a rural medically underserved area that provides ambulatory primary medical care under the general direction of a physician. If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice. A facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to tribal members admitted as inpatients or outpatients. Reimbursement, when no specific contracted rates are in place, are as follows: No. 1. The ICD-10 codes for the reason of the encounter should be billed in the primary position. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. identify telehealth or telephone (audio only) services that were historically performed in the office or other in person setting (E.g. Modifier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): . No additional modifiers are necessary. Cost-share was waived through February 15, 2021 dates of service. A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician. 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 . Certain virtual care services that were previously covered on an interim basis as part of our COVID-19 guidelines are now permanently covered as part of our Virtual Care Reimbursement Policy. 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. Prior authorization for treatment follows the same protocol as any other illness based on place of service and according to plan coverage. 3. NOTE: Please direct questions related to billing place of service codes to your Medicare Administrative Contractor (MAC) for assistance. As of January 1, 2022, a new POS code has been approved to report more specifically where services were provided. For more information about current Evernorth Behavioral Health virtual care guidance, please visit CignaforHCP.com > Resources > Behavioral Resources > Doing Business with Cigna > COVID-19: Interim Guidance. 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. ), 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. (As of 01/21/2021) What Common Procedural Technology (CPT) codes should be used for COVID-19 testing? Residential Substance Abuse Treatment Facility. The White House announced the intent to end both the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023. All health insurance policies and health benefit plans contain exclusions and limitations. As a reminder, standard customer cost-share applies for non-COVID-19 related services. (Effective January 1, 2020). Insurance Reimbursement Rates for Psychotherapy, Insurance Reimbursement Rates for Psychiatrists, Beginners Guide To Mental Health Billing, https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf, guide on HIPAA compliant video technology for telehealth, https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf, Inquire about our mental health insurance billing service, offload your mental health insurance billing, We charge a percentage of the allowed amount per paid claim (only paid claims). Cigna will not make any limitation as to the place of service where an eConsult can be used. Cigna commercial and Cigna Medicare Advantage are waiving the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. Bill those services on a CMS-1500 form or electronic equivalent. Heres how you know. Is there a code that we can use to bill for this other than 99441-99443? 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). ** The Benefits of Virtual Care No waiting rooms. 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. Listed below are place of service codes and descriptions. ICD-10 diagnosis codes that generally reflect non-covered services are as follows. Cigna covers the administration of the COVID-19 vaccine with no customer cost-share (i.e., no deductible or co-pay) when delivered by any provider or pharmacy. EAP sessions are allowed for telehealth services. 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. 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. Important notes, What the accepting facility should know and do. 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. No. all continue to be appropriate to use at this time. Yes. COVID-19 admissions would be emergent admissions and do not require prior authorizations. We maintain all current medical necessity review criteria for virtual care at this time. Paid per contract; standard cost-share applies. POS 11, 19 and 22) modifier GT or 95 (or GQ for Medicaid) must be used. Is Face Time allowed? Cigna remains adequately staffed to respond to all new precertification requests for elective procedures within our typical timelines. 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. Note that billing B97.29 will not waive cost-share. For more information, please visit Cigna.com/Coronavirus. 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). The Department may not cite, use, or rely on any guidance that is not posted 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. 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. Cigna covers pre-admission and pre-surgical COVID-19 testing with no customer cost-share when performed in an outpatient setting through at least May 11, 2023. Transport between facilities such as hospitals and SNFs and hospitals and Acute Rehab centers is also covered without prior authorization. When a customer receives virtual care services from their regular doctor (or any other provider) as part of this policy and when the provider bills with POS 02 customers with certain benefit plans may have a lower cost-share. 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. Throughout the pandemic, the emergency use authorized monoclonal antibody drug bebtelovimab was purchased by the federal government and offered to providers for free. Intermediate Care Facility/ Individuals with Intellectual Disabilities. An official website of the United States government Cigna will cover the administration of the COVID-19 vaccine with no customer cost-share even when administered by a non-participating provider following the guidance above. Cigna will only reimburse claims for covered OTC COVID-19 tests submitted by customers under their medical benefit and by certain pharmacy retailers under the pharmacy benefit, as elected by clients. Before sharing sensitive information, make sure youre on a federal government site. 3. A facility which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. 4. Effective January 1, 2022, eConsults remain covered, but cost-share applies for all covered services. Services provided on and after February 16, 2021 remain covered, but with standard customer cost-share.After the EUA or licensure of each COVID-19 treatment by the FDA, CMS will identify the specific drug code(s) along with the specific administration code(s) for each drug that should be billed. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). What place of service code should be used for telemedicine services? If you are looking for more comprehensive implementation . Talk privately with a licensed therapist or psychiatrist by appointment using your phone, tablet, or computer. were all appropriate to use through December 31, 2020. No. These codes should be used on professional claims to specify the entity where service(s) were rendered. 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. 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. 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. As long as one of these modifiers is included for the appropriate procedure code(s), the service will be considered to have been performed virtually. Denny and his team are responsive, incredibly easy to work with, and know their stuff. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 When the condition being billed is a post-COVID condition, please submit using ICD-10 code U09.9 and code first the specific condition related to COVID-19. (Description change effective January 1, 2016). 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. Yes. Emotional health resources have been added to the COVID-19 interim guidance page for behavioral providers at CignaforHCP.com. No additional modifiers are necessary to include on the claim. 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. Subscribe now with just HK$100. 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. Providers will not need a specific consent from patients to conduct eConsults. A facility which primarily provides to residents skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care services above the level of custodial care to other than individuals with intellectual disabilities. No. Virtual care offered by Urgent Care Centers billing with code S9083 is reimbursable until further notice. In addition, Cigna recognizes and expects that providers will continue to follow their usual business practices regarding onboarding new providers, locum tenens, and other providers brought in to cover practices or increase care during times of high demand. Product availability may vary by location and plan type and is subject to change. Yes. 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. website belongs to an official government organization in the United States. lock 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. A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. 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. 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. 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 dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. 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. 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. 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. For more information, see the resources along the right-hand side of the screen. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. Additionally, certain virtual care services and accommodations that are not generally reimbursable under the Virtual Care Reimbursement Policy remain reimbursable as part of our continued interim COVID-19 virtual care guidelines until further notice. When billing for the service, indicate the place of service as where the visit would have occurred if in person. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. State and federal mandates, as well as customer benefit plan designs, may supersede our guidelines. If you are rendering services as part of a facility (i.e., intensive outpatient program . They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. 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.). Schedule an appointment online with MDLIVE and visit a lab for your blood work and biometrics. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. The provider will need to code appropriately to indicate COVID-19 related services. 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. incorporated into a contract. 1 In an emergency, always dial 911 or visit the nearest hospital. 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. All other customers will have the same cost-share as if they received the services in-person from that same provider. Please review these changes by going to the Provider FastFax page and selecting fax number 30. And as customers 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. Details, Watch this short video to learn more about virtual care with MDLive. You get connected quickly. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. 1995-2020 by the American Academy of Orthopaedic Surgeons. 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. 1 An E&M service and COVID-19 vaccine administration code should only be billed when a significant and separately identifiable E&M visit was performed at the same time as the administration of the vaccine. Cigna covers the administration of the COVID-19 vaccine with no customer-cost share (i.e., no deductible or co-pay) when delivered by any provider. Store and forward communications (e.g., email or fax communications) are not reimbursable. The Virtual Care Reimbursement Policy also applies to non-participating providers. Washington, D.C. 20201 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). The covered procedure codes for E-visits/online portal services include: 99421, 99422, 99423, G2061, G2062, G2063. However, facilities will not be penalized financially for failure to notify us of admissions. HIPAA requirements apply to video telehealth sessions so please refer to our guide on HIPAA compliant video technology for telehealth to ensure youre meeting the requirements. Ultimately however, care must be medically necessary to be covered. We added a number of additional codes in March and April 2022 that are now eiligible for reimbursement. Recent guidelines have recommended keeping the normal service facility that you are registered under in your CMS-1500.
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