(Effective January 1, 2016). The .gov means its official. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. 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. Yes. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. The White House announced the intent to end both the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023. 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 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. Modifier CR or condition code DR can also be billed instead of CS. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. Hospitals are still required to make their best efforts to notify Cigna of hospital admissions in part to assist with discharge planning. On-demand virtual care for minor medical conditions, Talk therapy and psychiatry from the privacyof home. This includes when done by any provider at any site, including an emergency room, free-standing emergency room, urgent care center, other outpatient setting, physicians office, etc. Cigna covers the administration of the COVID-19 vaccine with no customer cost-share (i.e., no deductible or co-pay) when delivered by any provider or pharmacy. No. 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. Cigna understands the tremendous pressure our healthcare delivery systems are under. Contracted providers cannot balance bill customers for non-reimbursable codes. As of June 1, 2021, these plans again require referrals. Reimbursement for codes that are typically billed include: Yes. were all appropriate to use). For telehealth, the 95 modifier code is used as well. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. The facility that the patient is being transferred to (e.g., SNF, AR, or LTACH) is responsible for notifying Cigna of admissions the next business day. When billing, you must use the most appropriate code as of the effective date of the submission. Service performed: OEce or other outpatient visit for the evaluation and management of a new patient CPT code billed: 99202 Modier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): 100% of face-to-face rate Customer cost-share: Applies consistent with 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. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. Telehealth claims with any other POS will not be considered eligible for reimbursement. In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. ICD-10 diagnosis codes that generally reflect non-covered services are as follows. 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 (As of 01/21/2021) What Common Procedural Technology (CPT) codes should be used for COVID-19 testing? 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. As always, we remain committed to providing further updates as soon as they become available. 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. 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. Our policy allows for reimbursement of a variety of services typically performed in an office setting that are appropriate to also perform virtually. These include: Virtual preventive care, routine care, and specialist referrals. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. 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. Excluded physician services may be billed Yes. Cost-share will be waived only when providers bill the appropriate ICD-10 code (U07.1, J12.82, M35.81, or M35.89). A facility which primarily provides health-related care and services above the level of custodial care to individuals but does not provide the level of care or treatment available in a hospital or SNF. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 We will continue to monitor inpatient stays. Considering the pressure facilities are under, Cigna will extend the authorization approval window from three months to six months on request. In order to bill these codes, the test must be FDA approved or cleared or have received Emergency Use Authorization (EUA). Yes. When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance. 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. lock More information about coronavirus waivers and flexibilities is available on . Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication). 1. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. 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. A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided. CMS officially has designated a Place of Service code for all of the telehealth to be "02" starting April 1, 2020. Emotional health resources have been added to the COVID-19 interim guidance page for behavioral providers at CignaforHCP.com. 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. Standard customer cost-share applies. Modifier 95, GT, or GQ must be appended to the virtual care code(s). Cigna recommends video services but allows telephonic sessions; however they may require review for medical necessity. If specimen collection and a laboratory test are billed together, only the laboratory test will be reimbursed. Cigna will allow reimbursement for these codes by any provider or facility only when billed without any other codes (except where the contract allows it). Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. Listed below are place of service codes and descriptions. I cannot capture in words the value to me of TheraThink. incorporated into a contract. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. To speak with a dentist,log in to myCigna. 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. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. Is there a code that we can use to bill for this other than 99441-99443? 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. We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. 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. Denny and his team are responsive, incredibly easy to work with, and know their stuff. Through February 15, 2021, Cigna waived customer cost-share for any approved COVID-19 treatment, no matter the location of the service. 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. Mid-level practitioners (e.g., physician assistants and nurse practitioners) can also provide services virtually using the same guidance. Providers should append the GQ, GT, or 95 modifier and Cigna will reimburse them consistent with their face-to-face rates. This includes providers who typically deliver services in a facility setting. 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. Yes. When specific contracted rates are in place for COVID-19 vaccine administration services, Cigna will reimburse covered services at those contracted rates. Please review the "Virtual care services" frequently asked questions section on this page for more information. Under normal circumstances, the provider would bill with the Place of Service code 2, to indicate the care was rendered via telehealth. These resources offer access to live-guided relaxation sessions, wellness podcasts, and wellness and stress management flyers. Paid per contract; standard cost-share applies. 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. TheraThink.com 2023. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. Talk to a licensed dentist via a video call, 24/7/365. No. . In such cases, we will review the services provided on appeal for medical necessity to determine appropriate coverage.As a reminder, precertification is not required for the evaluation, testing, or medically necessary treatment of Cigna customers related to COVID-19. 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. identify telehealth or telephone (audio only) services that were historically performed in the office or other in person setting (E.g. Cigna covers Remdesivir for the treatment of COVID-19 when administered in inpatient or outpatient settings consistent with EUA usage guidelines and Cigna's Drug and Biologic Coverage Policy. Below is a definition of POS 02 and POS 10 for CMS-1500 forms, alongside a list of major insurance brands and their changes. Yes. Cigna does require prior authorization for fixed wing air ambulance transport. 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. Certain virtual care services that were previously covered on an interim basis as part of our COVID-19 guidelines are now permanently covered as part of our Virtual Care Reimbursement Policy. over a 7-day period. Washington, D.C. 20201 Similar to other providers and facilities, urgent care centers should bill just the appropriate COVID-19 vaccine administration code when that is the only service they are providing.Consistent with our reimbursement strategy for all other providers, urgent care centers will be reimbursed for covered vaccine administration services at contracted rates when specific contracted rates are in place for vaccine administration codes. Cigna may not control the content or links of non-Cigna websites. Intake / Evaluation (90791) Billing Guide, Evaluation with Medical Assessment (90792). For more information about current Evernorth Behavioral Health virtual care guidance, please visit CignaforHCP.com > Resources > Behavioral Resources > Doing Business with Cigna > COVID-19: Interim Guidance. Our data is encrypted and backed up to HIPAA compliant standards. 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. 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. Therefore, your patients with Cigna commercial coverage can purchase OTC tests from a health care provider and seek reimbursement by billing Cigna directly following our published guidance. 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. The U.S. Food and Drug Administration (FDA) recently approved for emergency use two prescription medications for the treatment of COVID-19: PaxlovidTM (from Pfizer) and molnupiravir (from Merck). Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. No. 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. INTERIM TELEHEALTH GUIDANCE Announcement from Cigna Behavioral Health . CPT 99490 covers at least 20 minutes of non-face-to-face chronic care management services provided by clinical staff. codes and normal billing procedures. Area (s) of Interest: Payor Issues and Reimbursement. That is why in 2015, CMS began reimbursing providers for a program called non-complex Chronic Care Management (CCM), billed as the new code CPT 99490. 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. 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. Telehealth can provide many benefits for your practice and your patients, including increased All synchronous technology used must be secure and meet or exceed federal and state privacy requirements. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. 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. 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. No. Activate your myCigna account nowto get access to a virtual dentist. Speak with a provider online and discuss your lab work, biometric screenings. A facility located in a medically underserved area that provides Medicare beneficiaries preventive primary medical care under the general direction of a physician. At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. 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. Approximately 98% of reviews are completed within two business days of submission. Cigna remains fully staffed, and is committed to ensuring that precertification requests are reviewed in a timely manner and that there is no interruption of claims processing or claims payments. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. Yes. . 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. Cigna Telehealth Place of Service Code: 02 Cigna Telehealth CPT Code Modifier: 95 We charge a percentage of the allowed amount per paid claim (only paid claims) No per claim submission fee No annual or monthly subscription fee The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). As a reminder, standard customer cost-share applies for non-COVID-19 related services. Yes. Previously, these codes were reimbursable as part of our interim COVID-19 accommodations. 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. on the guidance repository, except to establish historical facts. Effective for dates of service on and after January 1, 2021, we implemented a new R31 Virtual Care Reimbursement Policy. 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). The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). Prior authorization for treatment follows the same protocol as any other illness based on place of service and according to plan coverage. No. ( Cigna remains adequately staffed to respond to all new precertification requests for elective procedures within our typical timelines. eConsult services remain covered; however, customer cost-share applies as of January 1, 2022. Secure .gov websites use HTTPSA Until further notice, we will continue to made additional virtual care accommodations by allowing: eConsults are when a treating health care provider seeks guidance from a specialist physician through electronic means (e.g., phone, Internet, EHR consultation) to help manage care that is beyond the treating health care provider's usual practice.Typical examples include: Yes. The provider will need to code appropriately to indicate COVID-19 related services. Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. Cigna will not reimburse providers for the cost of the vaccine itself. 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. Yes. Yes. While we will not reimburse the drug itself when a provider receives it free of charge, we request that providers continue to bill the drug on the claim using the CMS code for the specific drug, along with a nominal charge (e.g., $.01), to assist with tracking purposes. means youve safely connected to the .gov website.
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