A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician's office. For virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02. Note that high-throughput tests may only be run in a high-complexity laboratory; The laboratory or provider bills using the codes in our interim billing guidelines and. Please visit CignaforHCP.com/virtualcare for additional information about that policy. Subscribe now with just HK$100. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. Cigna commercial and Cigna Medicare Advantage will not directly reimburse claims submitted under the medical benefit by retailers or by health care providers like hospitals, urgent care centers, and primary care groups for OTC COVID-19 tests, including when billed with CPT code K1034. No. Certain home health services can be provided virtually using synchronous communication as part of our R31 Virtual Care Reimbursement Policy. 24/7, live and on-demand for a variety of minor health care questions and concerns. When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. The Center for Medicare and Medicaid Services (CMS) has announced that there is to be a change in the telehealth place of service (POS) code for billing Medicare and Medicaid Services. 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. 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. Urgent care centers will not be reimbursed separately when they bill for multiple services. Cigna will also administer the waiver for self-insured group health plans and the company encourages widespread participation, although these plans will have an opportunity to opt-out of the waiver option or opt-in to extend the waiver past February 15, 2021. Speak with a provider online and discuss your lab work, biometric screenings. Schedule an appointment online with MDLIVE and visit a lab for your blood work and biometrics. As a reminder, standard customer cost-share applies for non-COVID-19 related services. Please review these changes by going to the Provider FastFax page and selecting fax number 30. For costs and details of coverage, review your plan documents or contact a Cigna representative. Cigna does require prior authorization for fixed wing air ambulance transport. No additional credentialing or notification to Cigna is required. Locations may have included hospitals, rehabilitation centers, skilled nursing facilities, temporary hospitals, or any other facility where treatment is generally provided. (As of 01/21/2021) What Common Procedural Technology (CPT) codes should be used for COVID-19 testing? One of our key goals is to help your patients connect to affordable, predictable, and convenient care anytime, anywhere. We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information. 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. All synchronous technology used must be secure and meet or exceed federal and state privacy requirements. Therefore, FaceTime, Skype, Zoom, etc. 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. Services include physical therapy, occupational therapy, and speech pathology services. (As of 10/14/2020) Where can providers access the telemedicine policy and related codes? 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. Yes. 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. A facility, other than a patient's home, in which palliative and supportive care for terminally ill patients and their families are provided. Talk to board-certified dermatologists without an appointment for customized care for skin, hair, and nail conditions. Once completed, telehealth will be added to your Cigna specialty. You can call, text, or email us about any claim, anytime, and hear back that day. Yes. Primary care physician referrals for specialist office visits were temporarily waived for Individual & Family Plans (IFP) in Illinois and for all SureFit plans through May 31, 2021. Yes. Cigna will not reimburse providers for the cost of the vaccine itself. 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 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). 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. No. Excluded physician services may be billed The Department may not cite, use, or rely on any guidance that is not posted No. Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. a listing of the legal entities A facility that provides the following services: outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically ill, and residents of the CMHC's mental health services area who have been discharged from inpatient treatment at a mental health facility; 24 hour a day emergency care services; day treatment, other partial hospitalization services, or psychosocial rehabilitation services; screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission; and consultation and education services. all continue to be appropriate to use at this time. No. Yes. Location, other than a hospital or other facility, where the patient receives care in a private residence. Effective for dates of service on and after January 1, 2021, we implemented a new R31 Virtual Care Reimbursement Policy. Effective Jan 1, 2022, the CMS changed the definition of POS code 02 we've been using for telehealth, and introduced a second telehealth POS code 10: POS 10: Telehealth to a client located at home (does not apply to clients in a hospital, nursing home or assisted living facility) POS 02: Telehealth to a client who is not located at home 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. 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. 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. Yes. On January 1, 2021, we implemented a Virtual Care Reimbursement Policy that ensures permanent coverage of certain virtual care services. POS codes are two-digit codes reported on . 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. When performing tests for these purposes, providers should bill the appropriate laboratory code (e.g., U0002) following our existing billing guidelines and testing coverage policy, and use the diagnosis code Z02.79 to indicate the test was performed for return-to-work or diagnosis code Z02.0 to indicate the test was performed for return-to-school purposes. Federal government websites often end in .gov or .mil. A facility maintained by either State or local health departments that provides ambulatory primary medical care under the general direction of a physician. Other Reimbursement Type. Routine and non-emergent transfers to a secondary facility continue to require authorization. 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). Diagnostic tests, which indicate if the individual carries the virus and can infect others, Serology (i.e., antibody) tests, which indicate if the individual had a previous infection and has now potentially developed an immune response, An individual seeks and receives a COVID-19 diagnostic test from a licensed or authorized health care provider; or, A licensed or authorized health care provider refers an individual for a COVID-19 diagnostic test; and, The laboratory test is FDA approved or cleared or has received Emergency Use Authorization (EUA); and, The test is run in a laboratory, office, urgent care center, emergency room, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU; and, The results of a molecular or antigen test are non-diagnostic for COVID-19 and the results of the antibody test will be used to aid in the diagnosis of a condition related to COVID-19 antibodies (e.g., Multisystem Inflammatory Syndrome); and. 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. ), Preventive care codes (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) (Effective with January 29, 2022 dates of service), A quick 5- to 10-minute telephone conversation between a provider and their patient (G2012), eConsults (99446-99449, 99451, and 99452), Virtual home health services (G0151, G0152, G0153, G0155, G0157, G0158, G0299, G0300, G0493, S9123, S9128, S9129, and S9131). For dates of service February 4, 2020 through February 15, 2021, Cigna covered COVID-19 treatments without customer cost-share. 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 Effective January 1, 2021, we implemented a new. MVP will email or fax updates to providers and will update this page accordingly. Providers will continue to be reimbursed at 100% of their face-to-face rates for covered virtual care services, even when billing POS 02. 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. 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. Total 0 Results. While we encourage providers to bill virtual care consistent with an office visit and understand that certain services can be time consuming and complex even when provided virtually we strongly encourage providers to be cognizant when billing level four and five codes for virtual services. Get non-narcotic prescriptions sent directly to your local pharmacy, if appropriate. Paid per contract; standard cost-share applies. A medical facility operated by one or more of the Uniformed Services. Place of Service 02 will reimburse at traditional telehealth rates. For covered virtual care services cost-share will apply as follows: No. DISCLAIMER: The contents of this database lack the force and effect of law, except as No. 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 . 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. No. Talk directly to board-certified providers 24/7 by video or phone for help with minor, non-life-threatening medical conditions1. 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. Residential Substance Abuse Treatment Facility. 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. Similar to non-diagnostic COVID-19 testing services, Cigna will only cover non-diagnostic return-to-work virtual care services when covered by the client benefit plan. Please note that if the only service rendered is a specimen collection and/or testing, and all of the required components for an evaluation and management (E/M) service code are not met, then only the code for the specimen collection or testing should be billed. COVID-19 admissions would be emergent admissions and do not require prior authorizations. Yes. Please note that some opt-outs for self-funded benefit plans may have applied. You can decide how often to receive updates. Telehealth can provide many benefits for your practice and your patients, including increased Place of Service (POS) equal to what it would have been had the service been provided in-person. Approximately 98% of reviews are completed within two business days of submission. 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. Yes. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Telehealth Provided Other than in Patients Home, Process for Requesting New Codes or Modification of Existing Codes, Place of Service Codes for Professional Claims (PDF), A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to American Indians and Alaska Natives who do not require hospitalization. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. Denny has interviewed hundreds of mental health practitioners to better understand their struggles and solutions, all with the goal of making the professional side of behavioral health a little easier, faster, and less expensive. Sign up to get the latest information about your choice of CMS topics. Certain PT, OT, and ST virtual care services remain reimbursable under the R31 Virtual Care Reimbursement Policy. While Cigna doesn't require further credentialing or license validation, and the provider can work under the scope of their license, providers are encouraged to inform Cigna when they will practice across state lines. For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. When multiple services are billed along with S9083, only S9083 will be reimbursed. As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. 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. For the immediate future, we will continue to reimburse virtual care services consistent with face-to-face rates. Yes. 4. representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). Intermediate Care Facility/ Individuals with Intellectual Disabilities. For services provided through February 15, 2021, providers will need to bill consistent with our interim billing guidelines by including the Diagnosis code (Dx) U07.1, J12.82, M35.81, or M35.89 on claims related to the treatment of COVID-19. This policy will be reviewed periodically for changes based on the evolving COVID-19 PHE and updated CMS or state specific rules 1 based on executive orders. A serology test is a blood test that measures antibodies. Reimbursement for codes that are typically billed include: Yes. 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.). Similar to other vaccination administration (e.g., a flu shot), an E&M service and 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. Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication). ) Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004. Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (LINA) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (NYLGICNY) (New York, NY), formerly known as Cigna Life Insurance Company of New York. 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. 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. These include: Virtual preventive care, routine care, and specialist referrals. 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. When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance. Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. Through March 31, 2021, if the customer already had an approved authorization request for the service, another precertification request was not needed if the patient is being referred to another similar participating provider that offers the same level of care (e.g., getting a CT scan at another facility within the same or separate facility group). 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. Comprehensive Outpatient Rehabilitation Facility. A facility whose primary purpose is education. POS 02: Telehealth Provided Other than in Patient's Home Cigna covers diagnostic antibody tests when the results of the antibody test will be used to aid in the diagnosis of a condition related to COVID-19 antibodies (e.g., Multisystem Inflammatory Syndrome). The provider will need to code appropriately to indicate COVID-19 related services. Area (s) of Interest: Payor Issues and Reimbursement. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing. While virtual care provided by an urgent care center is not covered per our R31 Virtual Care Reimbursement Policy, we continue to reimburse urgent care centers for delivering virtual care until further notice as part of our interim COVID-19 virtual care accommodations. Concurrent review will start the next business day with no retrospective denials. 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. Yes. Deliver services that are covered by the Virtual Care Reimbursement Policy; Bill consistently with the requirements of the policy; and. These codes do not need a place of service (POS) 02 or modifier 95 or GT. 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. M misstigris Networker Messages 63 Location Portland, OR 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. Location, distinct from a hospital emergency room, an office, or a clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention. Additional information about the COVID-19 vaccines, including planning for a vaccine, vaccine development, getting vaccinated, and vaccine safety can be found on the CDC website. 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. Yes. 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. The ICD-10 codes for the reason of the encounter should be billed in the primary position. This is a key difference between Commercial and Medicare risk . 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. 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. Unless your office was approved to be a facility to administer virtual patient care, then it is best to bill using the telehealth code (11) Office. 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). Providers receive reasonable reimbursement consistent with national CMS rates for administering EUA-approved COVID-19 vaccines. An official website of the United States government 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). State and federal mandates, as well as customer benefit plan designs, may supersede our guidelines. Yes. When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance. To this end, we appreciate the feedback and deep collaboration weve had with provider groups and medical societies regarding virtual care. 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). 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. lock A location which provides treatment for substance (alcohol and drug) abuse on an ambulatory basis. The additional 365 days added to the regular timely filing period will continue through the end of the Outbreak Period, defined as the period of the National Emergency (which is declared by the President and must be renewed annually) plus 60 days. The accelerated credentialing accommodation ended on June 30, 2022. UnitedHealthcare (UHC) is now requiring physicians to bill eligible telehealth services with place of service (POS) 02 for commercial products. For additional information about our Virtual Care Reimbursement Policy, please review the policy, contact your provider representative, or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). Summary of Codes for Use During State of Emergency. No. 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. 2. We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. 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. Free Account Setup - we input your data at signup. If a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. 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. 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. When all requirements are met, covered services are currently reimbursed at 100% of face-to-face rates (i.e., parity). 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. 3. These codes should be used on professional claims to specify the entity where service (s) were rendered.