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Customers will be referred to seek in-person care. 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. Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. 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. Unless telehealth requirements are . Cigna does require prior authorization for fixed wing air ambulance transport. An official website of the United States government. 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. 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. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. Please note that our interim COVID-19 virtual care guidelines were in place until December 31, 2020. M0222 (administration in facility setting): $350.50, M0223 (administration in home setting): $550.50. 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. A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. 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 test is FDA approved or cleared or have received Emergency Use Authorization (EUA); The test is run in a laboratory, office, urgent care center, emergency room, drive-thru testing site, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. Please review the Virtual care services frequently asked questions section on this page for more information. No additional modifiers are necessary to include on the claim. This code will only be covered where state mandates require it. 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. 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. 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. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. Yes. Yes. For telehealth services rendered by a facility provider, report the CPT/HCPCS code with the applicable revenue code as would normally be done for an in-person visit, and also append either modifier 95 or GT. 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). These codes do not need a place of service (POS) 02 or modifier 95 or GT. A portion of a hospitals main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. 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. (As of 10/14/2020) Where can providers access the telemedicine policy and related codes? 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. Standard cost-share will apply for the customer, unless waived by state-specific requirements. No. Cigna may not control the content or links of non-Cigna websites. As of February 16, 2021 dates of service, cost-share applies. Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours. Please note that cost-share still applies for all non-COVID-19 related services. 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. Providers administering the vaccine to individuals without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the Provider Relief Fund. Diluents are not separately reimbursable in addition to the administration code for the infusion. We continue to make several other accommodations related to virtual care until further notice. Cigna currently allows for the standard timely filing period plus an additional 365 days. No. 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. Approximately 98% of reviews are completed within two business days of submission. 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. This eases coordination of benefits and gives other payers the setting information they need. Live-guided relaxation by telephone Available for all providers at no cost Every Tuesday at 5:00pm ET Call 866.205.5379, enter passcode 113 29 178, and then press # Additional Resources Cigna Medicare Billing guidelines and telehealth Cigna Dental Interim Communication to Providers QualCare Workers Compensation Interim billing guidance a listing of the legal entities (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). 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). Effective with January 1, 2021 dates of service, we implemented a new Virtual Care Reimbursement Policy. As a reminder, standard customer cost-share applies for non-COVID-19 related services. Product availability may vary by location and plan type and is subject to change. 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. 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. In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. Cigna does not generally cover tests for asymptomatic individuals when the tests are performed for general public health surveillance, for employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19. Providers can, however, bill the vaccine code (e.g., 91300 for the Pfizer vaccine or 91301 for the Moderna vaccine) with a nominal charge (e.g., $.01), but it is not required to be billed in order to receive reimbursement for the administration of the vaccine. 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. Yes. No virtual care modifier is needed given that the code defines the service as an eConsult. For example, if a dietician or occupational therapist would typically see a patient in an outpatient setting, but that service is now provided virtually, that dietician or occupational therapist would bill the same way they do for that face-to-face visit using the existing codes on their fee schedule and existing claim form they typically bill with (e.g., CMS 1500 or UB-04) and append the GQ, GT, or 95 modifier. This is a key difference between Commercial and Medicare risk . A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician's office. POS codes are two-digit codes reported on . As private practitioners, our clinical work alone is full-time. 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. Talk directly to board-certified providers 24/7 by video or phone for help with minor, non-life-threatening medical conditions1. Therefore, to increase convenient 24/7 access to care if a customers preferred provider is unavailable in-person or virtually, covered virtual care is also available through national virtual care vendors like MDLive. POS 10 Telehealth provided in a patient's home was created for services provided remotely to a patient in their private residence. 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 allows modifiers GQ, GT, or 95 to indicate virtual care for all services. This guidance applies to all providers, including laboratories. Sign up to get the latest information about your choice of CMS topics. All Cigna pharmacy and medical plans will cover Paxlovid and molnupiravir at any pharmacy or doctors office (in- or out-of-network) that has them available. Note: We only work with licensed mental health providers. No. 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. 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. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. Through December 31, 2020 dates of service, providers could deliver virtual neuropsychological and psychological testing services and bill their regular face-to-face CPT codes that were on their fee schedule . The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). * POS code 10 POS code name The interim COVID-19 virtual care guidelines were solely in place through December 31, 2020, and this new policy took effect on January 1, 2022. 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. The site is secure. State and federal mandates, as well as customer benefit plan designs, may supersede our guidelines. 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. 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. We do not expect smaller laboratories or doctors' offices to be able to perform these tests. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. April 14, 2021. Urgent care centers will not be reimbursed separately when they bill for multiple services. 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. 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 The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. M misstigris Networker Messages 63 Location Portland, OR EAP sessions are allowed for telehealth services. If specimen collection and a laboratory test are billed together, only the laboratory test will be reimbursed. 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. 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. Therefore, please refer to those guidelines for services rendered prior to January 1, 2021. A facility or distinct part of a facility for psychiatric care which provides a total 24-hour therapeutically planned and professionally staffed group living and learning environment. We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice. If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice. You want to know you can call your billing admin, a real person you've already spoken with, and get immediate answers about your claims. Intermediate Care Facility/ Individuals with Intellectual Disabilities. Yes. Services may be rendered via telemedicine when the service is: A covered Health First Colorado benefit, Within the scope and training of an enrolled provider's license, and; Appropriate to be rendered via telemedicine.