In these cases, providers should bill their regular face-to-face codes that are on their fee schedule, and add the GQ, GT, or 95 modifier to indicate the services were performed virtually. No. We do not expect smaller laboratories or doctors' offices to be able to perform these tests. First Page. 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. 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. UnitedHealthcare (UHC) is now requiring physicians to bill eligible telehealth services with place of service (POS) 02 for commercial products. Cost share is waived for all covered eConsults through December 31, 2021. 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). Is there a code that we can use to bill for this other than 99441-99443? Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. 4. Under My Account > Settings > Practice Details, you can select the Insurance Place of Service code associated with sessions held via video. Cigna continues to require prior authorization reviews for routine advanced imaging. Thanks for your help! What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? The location where health services and health related services are provided or received, through telecommunication technology. POS codes are two-digit codes reported on . An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. No. Prior authorization for treatment follows the same protocol as any other illness based on place of service and according to plan coverage. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually until further notice. It's our goal to ensure you simply don't have to spend unncessary time on your billing. For additional information about our coverage of the COVID-19 vaccine, please review our. To speak with a dentist,log in to myCigna. 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. 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). When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). The covered procedure codes for E-visits/online portal services include: 99421, 99422, 99423, G2061, G2062, G2063. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. A medical facility operated by one or more of the Uniformed Services. 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). Let us handle handle your insurance billing so you can focus on your practice. Therefore, FaceTime, Skype, Zoom, etc. 3. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). 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. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Standard customer cost-share applies. website belongs to an official government organization in the United States. Add in the unnecessarily difficult insurance billing system and we run the risk of working way over full-time. When billing for the service, indicate the place of service as where the visit would have occurred if in person. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. 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. For dates of service February 4, 2020 through February 15, 2021, Cigna covered COVID-19 treatments without customer cost-share. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. Our data is encrypted and backed up to HIPAA compliant standards. We understand that it's important to actually be able to speak to someone about your billing. No. Considering the pressure facilities are under, Cigna will extend the authorization approval window from three months to six months on request. We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. Cigna may not control the content or links of non-Cigna websites. A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. 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. No. Cost-share will be waived only when providers bill the appropriate ICD-10 code (U07.1, J12.82, M35.81, or M35.89). The White House announced the intent to end both the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023. 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. An official website of the United States government. No. In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. 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. This form can be completed here:https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf. Cigna does not require prior authorization for home health services. We recommend providers bill POS 02 beginning July 1, 2022 for virtual services (instead of a face-to-face POS). Yes. It must be initiated by the patient and not a prior scheduled visit. 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. 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. Cigna waived cost-share for COVID-19 related treatment, in both inpatient and outpatient settings, through February 15, 2021 dates of service. 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. 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. Comprehensive Outpatient Rehabilitation Facility. (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. 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. Treatment is supportive only and focused on symptom relief. For dates of service April 14, 2020 through at least May 11, 2023, Cigna will cover U0003 and U0004 with no customer cost-share when billed by laboratories using high-throughput technologies as described by CMS. mitchellde True Blue Messages 13,505 Location Columbia, MO Best answers 2 Mar 9, 2020 #2 Those are the codes for a phone visit. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. 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. To this end, we appreciate the feedback and deep collaboration weve had with provider groups and medical societies regarding virtual care. These codes do not need a place of service (POS) 02 or modifier 95 or GT. We are your billing staff here to help. No. Secure .gov websites use HTTPSA When specific contracted rates are in place for COVID-19 specimen collection services, Cigna will reimburse covered services at those contracted rates. INTERIM TELEHEALTH GUIDANCE Announcement from Cigna Behavioral Health . No. 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. These codes should be used on professional claims to specify the entity where service (s) were rendered. Organizations that offer Administrative Services Only (ASO) plans will be opted in to waiving cost-share for this service as well. However, we believe that FDA and EUA-approved vaccines are safe and effective, and encourage our customers to get vaccinated. Effective January 1, 2021, we implemented a new. that insure or administer group HMO, dental HMO, and other products or services in your state). Effective January 1, 2022, eConsults remain covered, but cost-share applies for all covered services. As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. 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. 200 Independence Avenue, S.W. Additionally, Cigna also continues to provide coverage for COVID-19 tests that are administered with a providers involvement or prescription after individualized assessment as outlined in this section and in Cignas COVID-19 In Vitro Diagnostic Testing coverage policy. 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. When no specific contracted rates are in place, providers will be reimbursed $40 per dose for general vaccine administration and an additional $35.50 per dose for administering it in a home setting for total reimbursement of $75.50 per vaccine dose. COVID-19 admissions would be emergent admissions and do not require prior authorizations. Beginning January 15, 2022, and through at least the end of the PHE (. Product availability may vary by location and plan type and is subject to change. For virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02. 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. 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. Talk to a licensed dentist via a video call, 24/7/365. Antibody tests: 86328, 86769, 86408, 86409, 86413, and 0224U, Cigna covers diagnostic molecular and antigen tests for COVID-19 through at least. Through February 15, 2021, Cigna waived customer cost-share for any approved COVID-19 treatment, no matter the location of the service. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. 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. Cost-share is waived only when providers bill one of the identified codes. 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. Virtual care (also known as telehealth, or telemedicine) is the use of technology to connect with a provider by video or phone using a computer or mobile device. This code will only be covered where state mandates require it. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. Certain home health services can be provided virtually using synchronous communication as part of our R31 Virtual Care Reimbursement Policy. Location, other than a hospital or other facility, where the patient receives care in a private residence. We will continue to monitor inpatient stays. 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. These codes should be used on professional claims to specify the entity where service(s) were rendered. Primary care physician to specialist requesting input from a cardiologist, psychiatrist, pulmonologist, allergist, dermatologist, surgeon, oncologist, etc. For the purposes of private practice, the three most common service codes therapists are likely to bill are "11" (office), "12" (in-home services), and "2" (telehealth).