Yes. Modifier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): . 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. Clarifying Codes G0463 and Q3014 Unfortunately, this policy also created a great deal of confusion and inconsistency among providers regarding which code to bill when providing remote clinic visits: G0463, Hospital outpatient clinic visit for assessment and management of a patient, or Q3014, Telehealth originating site facility fee. As a result, we did not reimburse for the drug itself when billed with Q0222.However, on August 15, drug manufacturer Eli Lilly started commercial distribution of their COVID-19 monoclonal antibody therapy, bebtelovimab (175 mg), and the federal government will no longer purchase it. (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. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients. Certain home health services can be provided virtually using synchronous communication as part of our R31 Virtual Care Reimbursement Policy. 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. A facility which provides room, board and other personal assistance services, generally on a long-term basis, and which does not include a medical component. Please note that customer cost-share and out-of-pocket costs may vary for services customers receive through our virtual care vendor network (e.g., MDLive). 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. 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. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. 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). HIPAA does not require patient consent for consultation and coordination of care with health care providers in the ordinary course of treatment for their patients. The covered procedure codes for E-visits/online portal services include: 99421, 99422, 99423, G2061, G2062, G2063. When specific contracted rates are in place for COVID-19 specimen collection services, Cigna will reimburse covered services at those contracted rates. April 14, 2021. identify telehealth or telephone (audio only) services that were historically performed in the office or other in person setting (E.g. 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. Separate codes providers may use to bill for supplies are generally considered incidental to the overall primary service and are not reimbursed separately. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. 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 admitted as inpatients or outpatients. 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 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. 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. Yes. (Effective January 1, 2020). No. As of June 1, 2021, these plans again require referrals. These codes should be used on professional claims to specify the entity where service(s) were rendered. Transport between facilities such as hospitals and SNFs and hospitals and Acute Rehab centers is also covered without prior authorization. Cigna covers FDA EUA-approved laboratory tests. 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. https:// If a provider administers a quick uniform screening (questionnaire) that does not result in a full evaluation and management service of any level, and then performs a COVID-19 test OR a collection service, they should bill only the laboratory code OR collection code. If an urgent care center administers a quick uniform screening (questionnaire) that does not result in a full evaluation and management service of any level and then performs a COVID-19 test OR a collection service, they should bill only the laboratory code OR collection code. The provider will need to code appropriately to indicate COVID-19 related services. incorporated into a contract. 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. Cigna follows CMS rules related to the use of modifiers. When providers purchase the drug itself from the manufacturer (e.g., bebtelovimab billed with Q0222), Cigna will reimburse the cost of the drug when covered. Yes. While as part of this policy, Urgent Care centers billing virtual care on a global S code is not reimbursable, we do continue to reimburse these services until further notice as part of our interim COVID-19 guidelines. 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. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. All Time (0 Recipes) Past 24 Hours Past Week Past month. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. There may be limited exclusions based on the diagnoses submitted. 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. Yes. 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). Providers could deliver any face-to-face service on their fee schedule virtually, including those not related to COVID-19, for dates of service through December 31, 2020. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice. Let us handle handle your insurance billing so you can focus on your practice. means youve safely connected to the .gov website. Please note that some opt-outs for self-funded benefit plans may have applied. Cigna offers a number of virtual care options depending on your plan. Prior to the COVID-19 PHE, the patient's place of service was indicated with code 02, which previously indicated all telehealth patient sites. "Medicare hasn't identified a need for new POS code 10. When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9. (Description change effective January 1, 2016). For more information, including details on how you can get reimbursed for these tests from original Medicare when you directly supply them to your patients with Part B or Medicare Advantage plans, please, U0003: $75 per test (high-throughput PCR-based coronavirus test)*, U0004: $75 per test (any technique with high-throughput technology)*, U0005: $25 (when test results are returned within two days)*, Routine and/or executive physicals (Z02.89). No waiting rooms. No. 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. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. 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. Yes. Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. When specific contracted rates are in place for COVID-19 specimen collection, 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. For all virtual care services, providers should bill using a reimbursable face-to-face code, append the GQ, GT or 95 modifier, and use POS 02 as of July 1, 2022. When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). Codes on the list of approved telehealth services allow for various settings, but there must be both audio and video in real time between the physician . Listed below are place of service codes and descriptions. Talk to board-certified dermatologists without an appointment for customized care for skin, hair, and nail conditions. A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. DISCLAIMER: The contents of this database lack the force and effect of law, except as Cigna will factor in the current strain on health care systems and will incorporate this information into retrospective reviews. These codes should be used on professional claims to specify the entity where service (s) were rendered. We are your billing staff here to help. 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. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. 3. 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.). He co-founded a mental health insurance billing service for therapists called TheraThink in 2014 to specifically solve their insurance billing problems. We also referenced the current list of covered virtual care codes by the CMS to help inform our coverage strategy. Please note that while virtual care services billed on a UB-04 claim will not typically be reimbursed under this policy, we continue to reimburse virtual care services billed on a UB-04 claim form until further notice as a COVID-19 accommodation when the services: Please note that existing reimbursement policies will apply and may affect claims payment (e.g., R30 E&M Services). To sign up for updates or to access your subscriber preferences, please enter your contact information below. Therefore, please refer to those guidelines for services rendered prior to January 1, 2021. This will help us to meet customers' clinical needs and support safe discharge planning. Additionally, when you bill POS 02, your patients may also pay a lower cost-share for the virtual services they receive due to a recent change in some plan benefits. Yes. Billing guidelines: Optum Behavioral Health will reimburse telehealth services which use standard CPT codes and a GT modifier or a Place of Service of 02 for 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. Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. 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). Certain client exceptions may apply to this guidance. For the R31 Virtual Care Reimbursement Policy, effective January 1, 2021, we continue to not make any requirements regarding the type of synchronous technology used until further notice. Service codes Physicians: use service codes 99441-99443; Non-physicians: use 98966-98968 We're waiving copays for telehealth visits for behavioral and mental health counseling for members eligible for managed long-term services and supports (MLTSS) and Division of Developmental . Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. The White House announced the intent to end both the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023. 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. My daily insurance billing time now is less than five minutes for a full day of appointments. 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. 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. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. 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. 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. It must be initiated by the patient and not a prior scheduled visit. An official website of the United States government Per usual policy, Cigna does not require three days of inpatient care prior to transfer to a SNF. End-Stage Renal Disease Treatment Facility. No additional modifiers are necessary to include on the claim. For services provided through February 15, 2021, providers will need to bill consistent with our interim billing guidelines by including the Diagnosis code (Dx) U07.1, J12.82, M35.81, or M35.89 on claims related to the treatment of COVID-19. Yes. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually until further notice. As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. 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. Effective for dates of service on and after January 1, 2021, we implemented a new R31 Virtual Care Reimbursement Policy. 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 Cigna remains adequately staffed to respond to all new precertification requests for elective procedures within our typical timelines. No authorization is required for the procurement or administration of COVID-19 infusion treatments. 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. Product availability may vary by location and plan type and is subject to change. Coverage reviews for appropriate levels of care and medical necessity will still apply. We will continue to monitor inpatient stays. Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. No. Yes. We understand that it's important to actually be able to speak to someone about your billing. 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. However, providers are required to attest that their designated specialty meets the requirements of Cigna. Through February 15, 2021, Cigna waived customer cost-share for any approved COVID-19 treatment, no matter the location of the service. 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. Get non-narcotic prescriptions sent directly to your local pharmacy, if appropriate. 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. Billing for telehealth nutrition services may vary based on the insurance provider. Please note that we continue to closely monitor and audit claims for inappropriate services that could not be performed virtually (e.g., acupuncture, all surgical codes, anesthesia, radiology services, laboratory testing, administration of drugs and biologics, infusions or vaccines, EEG or EKG testing, etc.). For telephone services only, codes are time based. Concurrent review will start the next business day with no retrospective denials. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. However, facilities will not be penalized financially for failure to notify us of admissions. Under normal circumstances, the provider would bill with the Place of Service code 2, to indicate the care was rendered via telehealth. 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. You get connected quickly. Please note that this list is not all inclusive and may not represent an exact indication match. In 2017, Cigna launched behavioral telehealth sessions for all their members. No. We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information. Please note that we continue to request that providers do not bill with modifiers 93 or FQ at this time. Cost-share is waived only when providers bill one of the identified codes. (As of 10/14/2020) Where can providers access the telemedicine policy and related codes? When no specific contracted rates are in place, Cigna will reimburse all covered COVID-19 diagnostic tests consistent with CMS reimbursement to ensure consistent, timely, and reasonable reimbursement. Once completed, telehealth will be added to your Cigna specialty. Listed below are place of service codes and descriptions. We are awaiting further billing instructions for providers, as applicable, from CMS. 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. Yes. new codes. lock M0222 (administration in facility setting): $350.50, M0223 (administration in home setting): $550.50. While we encourage providers to bill virtual care consistent with an office visit and understand that certain services can be time consuming and complex even when provided virtually we strongly encourage providers to be cognizant when billing level four and five codes for virtual services. Similar to other vaccination administration (e.g., a flu shot), an E&M service and 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. We did not make any requirements regarding the type of technology used. However, we believe that FDA and EUA-approved vaccines are safe and effective, and encourage our customers to get vaccinated. 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. You can call, text, or email us about any claim, anytime, and hear back that day. Our data is encrypted and backed up to HIPAA compliant standards. Yes, the cost-share waiver for COVID-19 treatment ended on February 15, 2021. Please review our COVID-19 In Vitro Diagnostic Testing coverage policy for a list of additional services and ICD-10 codes that are generally not covered. 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. U.S. Department of Health & Human Services Through March 31, 2021, if the customer already had an approved authorization request for the service, another precertification request was not needed if the patient is being referred to another similar participating provider that offers the same level of care (e.g., getting a CT scan at another facility within the same or separate facility group). For example, an infectious disease specialist could provide a virtual consultation for an ICU patient, document the level of care provided, bill the appropriate face-to-face E&M code with modifier GQ, GT, or 95, and be reimbursed at the face-to-face rate. Emergent transport to nearby facilities capable of treating customers is covered without prior authorization. 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 (whether billed on the same or different claims). Providers can bill code G2012 for a quick 5-10 minute phone conversation as part of our R31 Virtual Care Reimbursement Policy, with cost-share waived through at least May 11, 2023 for customers when the conversation is related to COVID-19. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with the CMS reimbursement rates noted below to ensure timely, consistent and reasonable reimbursement. 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 the immediate future, we will continue to reimburse virtual care services consistent with face-to-face rates. on the guidance repository, except to establish historical facts. We continue to make several other accommodations related to virtual care until further notice. Audio-only encounters can be provided using the telephone evaluation and management codes (CPT codes. Intermediate Care Facility/ Individuals with Intellectual Disabilities. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically A freestanding facility, other than a physician's office, where surgical and diagnostic services are provided on an ambulatory basis. We also continue to work directly with providers to understand the financial implications that virtual care reimbursement may have on practices. COVID-19 OTC tests used for employment, travel, participation in sports or other activities are not covered under this mandate. over a 7-day period. A facility maintained by either State or local health departments that provides ambulatory primary medical care under the general direction of a physician. Cigna will not make any requirements as it relates to virtual services being for a new or existing patient. Our mental health insurance billing staff is on call Monday Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy. Important notes: For additional information about Cigna's coverage of medically necessary diagnostic COVID-19 tests, please review the COVID-19 In Vitro Diagnostic Testing coverage policy. 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. Following the recent statement from the National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel indicating that a three-dose regimen of Remdesivir in the outpatient setting can be effective in preventing progression to severe COVID-19, CMS created HCPCS code J0248 when administering Remdesivir in an outpatient setting. Effective for dates of service on and after March 2, 2020 until further notice, Cigna will cover eConsults when billed with codes 99446-99449, 99451 and 99452 for all conditions. 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.
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