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As a reminder, standard customer cost-share applies for non-COVID-19 related services. When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance. This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice. 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. Activate your myCigna account nowto get access to a virtual dentist. 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. Is there a code that we can use to bill for this other than 99441-99443? means youve safely connected to the .gov website. Claims were not denied due to lack of referrals for these services during that time. These codes should be used on professional claims to specify the entity where service (s) were rendered. In these cases, the non-credentialed provider can bill under the group assuming they are practicing within state laws to administer the vaccine. Cigna ultimately looks to the FDA, CDC, and ACIP to determine these factors. 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. Cigna Telehealth Place of Service Code: 02. Yes. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. State and federal mandates, as well as customer benefit plan designs, may supersede our guidelines. Hi Laelia, I'd be happy to help. As of June 1, 2021, these plans again require referrals. As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. No. Schedule an appointment online with MDLIVE and visit a lab for your blood work and biometrics. CPT 99490 covers at least 20 minutes of non-face-to-face chronic care management services provided by clinical staff. Instead, U07.1, J12.82, M35.81, or M35.89 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnosis. Cigna does require prior authorization for fixed wing air ambulance transport. When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. A facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on a 24-hour basis, by or under the supervision of a physician. 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. Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. Providers that administer vaccinations to patients without health insurance or whose insurance does not provide coverage of vaccination administration fees, may be able to file a claim with the provider relief fund, but may not charge patients directly for any vaccine administration costs. 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. Cigna remains adequately staffed to respond to all new precertification requests for elective procedures within our typical timelines. We will also closely monitor and audit claims for inappropriate services that should not be performed virtually (including but not limited to: acupuncture, all surgical codes, anesthesia, radiology services, laboratory testing, administration of drugs and biologics, infusions or vaccines, and EEG or EKG testing). were all appropriate to use). Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. new codes. Claims must be submitted on a CMS-1500 form or electronic equivalent. Get non-narcotic prescriptions sent directly to your local pharmacy, if appropriate. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. However, Cigna will still consider requestes for accelerated credentialing on a case-by-case basis. A facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program for patients who do not require full time hospitalization, but who need broader programs than are possible from outpatient visits to a hospital-based or hospital-affiliated facility. 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. (As of 10/14/2020) Where can providers access the telemedicine policy and related codes? Effective January 1, 2022, eConsults remain covered, but cost-share applies for all covered services. Yes. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. No. Telephone, Internet, or electronic health record consultations of less than five minutes should not be billed. We are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. Other Reimbursement Type. POS 02: Telehealth Provided Other than in Patient's Home representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). Congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services. 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. Ultimately however, care must be medically necessary to be covered. 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. The covered procedure codes for E-visits/online portal services include: 99421, 99422, 99423, G2061, G2062, G2063. 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. 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 will generally not cover in-vitro molecular, antigen, or antibody tests for asymptomatic individuals. 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. 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, Most synchronous technology to be used (e.g., FaceTime, Skype, Zoom, etc. Virtual care offered by Urgent Care Centers billing with code S9083 is reimbursable until further notice. April 14, 2021. 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. 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. 3 Biometric screening experience may vary by lab. The provider will need to code appropriately to indicate COVID-19 related services. Effective with January 1, 2021 dates of service, we implemented a new Virtual Care Reimbursement Policy. For more information, see the resources along the right-hand side of the screen. 1 In an emergency, always dial 911 or visit the nearest hospital. 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. No additional modifiers are necessary to include on the claim. Cigna allows modifiers GQ, GT, or 95 to indicate virtual care for all services. Reimbursement for the administration of the injection will remain the same. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). NOTE: Please direct questions related to billing place of service codes to your Medicare Administrative Contractor (MAC) for assistance. Note that billing B97.29 will not waive cost-share. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. 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.). 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. For more information about current Evernorth Behavioral Health virtual care guidance, please visit CignaforHCP.com > Resources > Behavioral Resources > Doing Business with Cigna >, For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com >, Outpatient E&M codes for new and established patients (99202-99215), Physical and occupational therapy E&M codes (97161-97168), Annual wellness visit codes (G0438 and G0439), Services must be on the list of eligible codes contained within in our. "All Rights Reserved." This website and its contents may not be reproduced in whole or in part without . for services delivered via telehealth. Our policy allows for reimbursement of a variety of services typically performed in an office setting that are appropriate to also perform virtually. Transport between facilities such as hospitals and SNFs and hospitals and Acute Rehab centers is also covered without prior authorization. End-Stage Renal Disease Treatment Facility. Providers should bill one of the above codes, along with: No. List the address of the physician for the telehealth visit on the CMS1500 claim. Before sharing sensitive information, make sure youre on a federal government site. Providers will not need a specific consent from patients to conduct eConsults. Cigna understands the tremendous pressure our healthcare delivery systems are under. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. Please visit. 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. We also continue to work directly with providers to understand the financial implications that virtual care reimbursement may have on practices. 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). No waiting rooms. Modifier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): . They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. 3. When billing for telehealth, it's unclear what place of service code to use. No. Cost share is waived for all covered eConsults through December 31, 2021. 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. Place of Service 02 will reimburse at traditional telehealth rates. (Effective January 1, 2003), 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 who do not require hospitalization.