Cigna Telehealth Service is a one-stop mobile app for having virtual consultation with doctors in Hong Kong as well as getting Covid-19 self-test kit & medication delivered to your doorstep. Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004. Yes. The accelerated credentialing accommodation ended on June 30, 2022. 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). 24/7, live and on-demand for a variety of minor health care questions and concerns. A location which provides treatment for substance (alcohol and drug) abuse on an ambulatory basis. 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. Federal government websites often end in .gov or .mil. Let us handle handle your insurance billing so you can focus on your practice. (99441, 98966, 99442, 98967, 99334, 98968). Standard customer cost-share applies. 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. Emotional health resources have been added to the COVID-19 interim guidance page for behavioral providers at CignaforHCP.com. 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. When no specific contracted rates are in place, Cigna will reimburse the administration of all EUA vaccines at the established national CMS rates when claims are submitted under the medical benefit to ensure timely, consistent, and reasonable reimbursement. You get connected quickly. Please note that our interim COVID-19 virtual care guidelines were in place until December 31, 2020. (As of 01/21/2021) What Common Procedural Technology (CPT) codes should be used for COVID-19 testing? We also referenced the current list of covered virtual care codes by the CMS to help inform our coverage strategy. First Page. 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. In addition, Anthem would recognize telephonic-only . Billing for telehealth nutrition services may vary based on the insurance provider. A facility maintained by either State or local health departments that provides ambulatory primary medical care under the general direction of a physician. 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. Modifier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): . 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. We did not make any requirements regarding the type of technology used. **, Watch this short video to learn more about virtual care with MDLivefor Cigna.(Length: 00:01:33). Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. No. Per usual protocol, emergency and inpatient imaging services do not require prior authorization. MLN Matters article MM12549, CY2022 telehealth update Medicare physician fee schedule. This will help us to meet customers' clinical needs and support safe discharge planning. Yes. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. CMS now defines these two telemedicine place of service (POS) codes: POS 02: Telehealth Provided Other than in Patient's Home Descriptor: The location where health services and health related services are provided or received, through telecommunication technology. eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. Cigna's Virtual Care (Telehealth) Services - Global Health Service Company A home health care provider should bill one of the covered home health codes for virtual services (G0151, G0152, G0153, G0155, G0157, G0158, G0299, G0300, G0493, S9123, S9128, S9129, and S9131) along with POS 12 and a GT or 95 modifier to identify that the service(s) were delivered using both an audio and video connection. As always, we remain committed to providing further updates as soon as they become available. 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. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. 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. TheraThink provides an affordable and incredibly easy solution. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. Additional FDA EUA approved vaccines will be covered consistent with this guidance. This will allow for quick telephonic consultations related to COVID-19 screening or other necessary consults, and will offer appropriate reimbursement to providers for this amount of time. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. The interim COVID-19 virtual care guidelines as outlined on this page were in place for dates of service through December 31, 2020. MLN Matters article MM7631, Revised and clarified place of service (POS) coding instructions. Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. Store and forward communications (e.g., email or fax communications) are not reimbursable. Modifier 95, GT, or GQ must be appended to the appropriate CPT or HCPCS procedure code(s) to indicate the service was for virtual care. Other Reimbursement Type. Yes. TheraThink.com 2023. A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician. Yes. When multiple services are billed along with S9083, only S9083 will be reimbursed. We hope you join us in our journey to offer our customers increased access to virtual care and appreciate your commitment to work with us as our virtual care platform continues to evolve to the meet the needs of our providers, customers, and clients. No. 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. *Please Note: virtual check-in and E-visit codes must be billed with Place of Service (POS) 02 and modifier GT. Cigna may not control the content or links of non-Cigna websites. Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. 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. mitchellde True Blue Messages 13,505 Location Columbia, MO Best answers 2 Mar 9, 2020 #2 Those are the codes for a phone visit. For services where COVID-19 is not the initial clinical presentation (e.g., appendectomy, labor and delivery, etc. Billing Guidelines: Optum will reimburse telehealth services which use standard CPT codes for outpatient treatment and a GT, GQ or 95 modifier for either a video-enabled virtual visit or a telephonic session, to indicate the visit was conducted remotely. No. Per CMS, individuals without health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost. These codes should be used on professional claims to specify the entity where service (s) were rendered. Telemedicine and COVID-19 | Frequently asked questions - CodingIntel No. a listing of the legal entities Listing Results Cigna Telehealth Place Of Service. The location where health services and health related services are provided or received, through telecommunication technology. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. Cigna follows CMS rules related to the use of modifiers. At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. 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. Cigna does not require prior authorization for home health services. Under normal circumstances, the provider would bill with the Place of Service code 2, to indicate the care was rendered via telehealth. Claims were not denied due to lack of referrals for these services during that time. 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. Thank you. ) Please note that we continue to request that providers do not bill with modifiers 93 or FQ at this time. (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. 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. No. 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). Cigna does not provide additional reimbursement for PPE-related costs, including supplies, materials, and additional staff time (e.g., CPT codes 99072 and S8301), as office visit (E&M) codes include overhead expenses, such as necessary PPE. Obtain your Member Code with just HK$100. Yes. Generally, only well-equipped commercial laboratories and hospital-based laboratories will have the necessary equipment to offer these tests. Cigna will 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, EEG or EKG testing). Know how to bill a facility fee Yes. Prior authorization is not required for COVID-19 testing. You can decide how often to receive updates. Billing the appropriate administration code will ensure that cost-share is waived. Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. ), Preventive care services (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) [Effective with January 29, 2022 dates of service]. 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. Yes. The .gov means its official. Place of Service 02 will reimburse at traditional telehealth rates. When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance. You can call, text, or email us about any claim, anytime, and hear back that day. all continue to be appropriate to use at this time. If a hospitalist is the treating provider, they would not be reimbursed for two services on the same day, as only one service is reimbursed per day, regardless of billing method. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. MVP will email or fax updates to providers and will update this page accordingly. Provider COVID-19 Updates - MVP Health Care The ICD-10 codes for the reason of the encounter should be billed in the primary position. 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. 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). For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. Approximately 98% of reviews are completed within two business days of submission. We also continue to work directly with providers to understand the financial implications that virtual care reimbursement may have on practices. No additional credentialing or notification to Cigna is required. 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. 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. Organizations that offer Administrative Services Only (ASO) plans will be opted in to waiving cost-share for this service as well. We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information. Further, we will continue to monitor virtual care health outcomes and claims data as well as provider, customer, and client feedback to ensure that our reimbursement and coverage strategy continues to meet the needs of those we serve. Services include methadone and other forms of Medication Assisted Treatment (MAT). When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance. 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. If the patient is in their home, use "10". 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. We do not expect smaller laboratories or doctors' offices to be able to perform these tests. Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. MLN Matters article MM12427, New modifications to place of service (POS) codes for telehealth. The patient may be either a new patient to the consultant or an established patient with a new problem or an exacerbation of an existing problem. All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. Because we believe virtual care has the potential to help you attract and retain patients, reduce access barriers, and contribute to your ability to provide the right care at the right time, we wanted to implement a policy that ensures you can continue to receive ongoing reimbursement for virtual care that you deliver to your patients with Cigna commercial medical coverage. While the R31 Virtual Care Reimbursement Policy that went into effect on January 1, 2021 only applies to claims submitted on a CMS-1500 claim form, we will continue to reimburse virtual care services billed on a UB-04 claim form until further notice when the services: Please note that existing reimbursement policies will apply and may affect claims payment (e.g., R30 E&M Services). Prior authorization for treatment follows the same protocol as any other illness based on place of service and according to plan coverage. For telehealth, the 95 modifier code is used as well. 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. On Aug. 3, 2020 CMS published a revision to the April 27th, 2020 memo announcing the addition of telephonic CPT codes (98966-98968, 99441-99443) valid for 2020 benefit year data submissions for the Department of Health and Human Services- (HHS-) operated risk adjustment program. Under My Account > Settings > Practice Details, you can select the Insurance Place of Service code associated with sessions held via video. These codes should be used on professional claims to specify the entity where service (s) were rendered. We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. PDF FAQs for Illinois Medicaid Virtual Healthcare Expansion/Telehealth that insure or administer group HMO, dental HMO, and other products or services in your state). Urgent Care vs. the Emergency Room7 Ways to Help Pay Less for Out-of-Pocket Costs, What is Preventive Care?View all articles. Effective with January 1, 2021 dates of service, we implemented a new Virtual Care Reimbursement Policy. When all requirements are met, covered services are currently reimbursed at 100% of face-to-face rates (i.e., parity). For a complete list of billing requirements, please review the Virtual Care Reimbursement Policy. Because health care providers are the most trusted source of information for consumers who are hesitant about receiving the vaccine, we continue to encourage providers to proactively educate their patients especially those who may have vaccine hesitancy or who are at high-risk of severe COVID-19 illness on the safety, effectiveness, and availability of the vaccine. Telehealth Visits | AAFP Activate your myCigna account nowto get access to a virtual dentist. Get non-narcotic prescriptions sent directly to your local pharmacy, if appropriate. Services performed on and after March 1, 2023 would have just their standard timely filing window. New/Modifications to the Place of Service (POS) Codes for Telehealth. Place of Service Code Set. Youll receive a summary of your screening results for your records. A medical facility operated by one or more of the Uniformed Services. Cigna will reimburse Remdesivir for COVID-19 treatment when administered in inpatient or outpatient settings at the national CMS reimbursement rate (or average wholesale pricing [AWP] if a CMS rate is not available) when the drug costs are not included in case rates or per diems to ensure timely, consistent, and reasonable reimbursement. As of January 1, 2022, a new POS code has been approved to report more specifically where services were provided. Effective January 1, 2021, we implemented a new. This article was updated on March 28, 2020 by adding a link to American Specialty Health and updating the place of service code to use on the 1500-claim form. For virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02. R33 COVID-19 Interim Billing Guidelines policy, COVID-19: In Vitro Diagnostic Testing coverage policy, COVID-19 In Vitro Diagnostic Testing coverage policy, Express Scripts discount prescription program, Centers for Medicare & Medicaid Services (CMS) COVID-19 vaccine resources, Cigna Coronavirus (COVID-19) Resource Center, 0001A, 0002A, 0003A, 0004A, 0011A, 0012A, 0013A, 0031A, 0034A, 0041A, 0042A, 0044A, 0051A, 0052A, 0053A, 0054A, 0064A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A, 0124A, 0134A, 0144A, 0154A, 0164A, 0173A, and M0201, Virtual screening telephone consult (5-10 minutes), Virtual or face-to-face visit for treatment of a, Drug and administration of infusion treatments for a confirmed COVID-19 case, M0220, M0221, M0222, M0223, M0240, M0241, M0243, M0244, M0245, M0246, M0247, M0248, M0249, Q0222, and M0250, COVID-19 laboratory testing (including PCR, antigen, and serology [i.e., antibody] tests), COVID-19 related diagnostic tests (other than COVID-19 test), Non COVID-19 virtual visit (i.e., telehealth), In-office or facility visit not related to COVID-19, Pfizer-BioNTech COVID-19 Vaccine Administration First Dose, Pfizer-BioNTech COVID-19 Vaccine Administration Second Dose, Pfizer-BioNTech COVID-19 Vaccine Administration Third Dose, Pfizer-BioNTech COVID-19 Vaccine Administration Booster, Moderna COVID-19 Vaccine Administration First Dose, Moderna COVID-19 Vaccine Administration Second Dose, Moderna COVID-19 Vaccine Administration Third Dose, Janssen COVID-19 Vaccine Administration Booster, Novavax COVID-19 Vaccine, Adjuvanted Administration First Dose, Novavax COVID-19 Vaccine, Adjuvanted Administration Second Dose, Novavax COVID-19 Vaccine, Adjuvanted Administration Booster, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - First dose, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Second dose, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Third dose, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Booster, Moderna COVID-19 Vaccine (Low Dose) Administration Booster, Pfizer-BioNTech COVID-19 Pediatric Vaccine Administration First dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine Administration Second dose, Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration Third dose, Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration Booster, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration First dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration Second dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration Third dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration First dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration Second dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration Third dose, Moderna COVID-19 Vaccine (Blue Cap) 50MCG/0.5ML Administration Booster, Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration First dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration Second dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration Third dose, Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Gray Cap) Administration Booster Dose, Moderna COVID-19 Vaccine, Bivalent (Aged 18 years and older) (Dark Blue Cap with gray border) Administration Booster Dose, Moderna COVID-19 Vaccine, Bivalent (Aged 6 years through 11 years) (Dark Blue Cap with gray border) Administration Booster Dose, Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 5 years through 11 years) (Orange Cap) Administration Booster Dose, Moderna COVID-19 Vaccine, Bivalent (Aged 6 months through 5 years) (Dark Pink Cap and label with a yellow box) Administration Booster Dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration Third dose, The initial COVID-19 diagnostic service (virtually, in an office, or at an emergency room, urgent care center, drive thru specimen collection center, or other facility), Specimen collection by a health care provider, Laboratory test (performed by state, hospital, or commercial laboratory; or other provider), Treatment (treatments that Cigna will cover for COVID-19 are those covered under Medicare or other applicable state regulations).