Please note that this list is not all inclusive and may not represent an exact indication match. Evernorth Provider - Resources - COVID-19: Interim Guidance 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). Telemedicine and COVID-19 | Frequently asked questions - CodingIntel Cigna Telehealth Service Audio -only CPT codes 98966 98968 and 99441 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. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. For virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02. Please note that while Cigna Medicare Advantage plans do fully cover the costs for COVID-19 tests done in a clinical setting, costs of at-home COVID-19 tests are not a covered benefit. Listed below are place of service codes and descriptions. This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. Yes. One of our key goals is to help your patients connect to affordable, predictable, and convenient care anytime, anywhere. Yes. When a customer receives virtual care services from their regular doctor (or any other provider) as part of this policy and when the provider bills with POS 02 customers with certain benefit plans may have a lower cost-share. In addition to the in-office care that you deliver today, we encourage you to consider offering virtual care to your patients with Cigna coverage as well and ensure theyre aware that you can continue to offer ongoing covered virtual care as they need it and as its medically appropriate. Cigna will also administer the waiver for self-insured group health plans and the company encourages widespread participation, although these plans will have an opportunity to opt-out of the waiver option or opt-in to extend the waiver past February 15, 2021. Once completed, telehealth will be added to your Cigna specialty. Similarly, if a cardiologist is brought in to consult in a face-to-face setting within a facility setting, that cardiologist can also provide services virtually billing a face-to-face evaluation and management (E&M) visit (the same code[s] on their fee schedule and the same claim form [e.g., CMS 1500 or UB-04]). When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 Please review the "Virtual care services" frequently asked questions section on this page for more information. As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. 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. Telephone, Internet, or electronic health record consultations of less than five minutes should not be billed. However, we believe that FDA and EUA-approved vaccines are safe and effective, and encourage our customers to get vaccinated. Therefore, effective with August 15 dates of service, Cigna will reimburse providers consistent with CMS rates for doses of bebtelovimab that they purchase directly from the manufacturer. Other Reimbursement Type. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. No. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. ), Preventive care services (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) [Effective with January 29, 2022 dates of service]. This form can be completed here:https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf. However, Cigna will still consider requestes for accelerated credentialing on a case-by-case basis. 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. No. Cigna does not reimburse an originating site of service fee or facility fee for telehealth visits, including for code Q3014, as they are not a covered benefit. To sign up for updates or to access your subscriber preferences, please enter your contact information below. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. COVID-19 Telemedicine - Humana Yes. Cigna currently allows for the standard timely filing period plus an additional 365 days. For example, if the Outbreak Period ends March 1, 2023, any service performed on or before that date will have its standard timely filing window begin upon the expiration of the Outbreak Period (here, March 1, 2023). If antibodies are present, it means that individual previously had a specific viral or bacterial infection - like COVID-19. We are actively reviewing all COVID-19 state mandates and will continue to share any changes and more details around coverage, reimbursement, and cost-share as applicable. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. CMS Introduces Changes to POS Codes That Will Affect Telehealth Billing 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). The ICD-10 codes for the reason of the encounter should be billed in the primary position. POS 02: Telehealth Provided Other than in Patient's Home 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). When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance. This policy applied to customers in the United States who are covered under Cigna's employer/union sponsored insured group health plans, insured plans for US-based globally mobile individuals, Medicare Advantage, and Individual and Family Plans (IFP). Contracted providers cannot balance bill customers for non-reimbursable codes. Update to the telehealth Place of Service (POS) code - Aetna Over the past several years and accelerated during COVID-19 we have collaborated with and sought feedback from many local and national medical societies, provider groups in our network, and key collaborative partners that have suggested certain codes and services that should be addressed in a virtual care reimbursement policy. To speak with a dentist,log in to myCigna. COVID-19 admissions would be emergent admissions and do not require prior authorizations. 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. The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. If the home health service(s) are done for COVID-19 related treatment, cost-share will be waived for covered services through February 15, 2021 when providers bill ICD-10 code U07.1, J12.82, M35.81, or M35.89. 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. A location which provides treatment for substance (alcohol and drug) abuse on an ambulatory basis. Modifier 95, indicating that you provided the service via telehealth. 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. Please note that cost-share still applies for all non-COVID-19 related services. When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance. 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. Out of Network Billing in Private Practice | How to Create a Superbill Paid per contract; standard cost-share applies. Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually until further notice. Every provider we work with is assigned an admin as a point of contact. You'll always be able to get in touch. Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. All Time (0 Recipes) Past 24 Hours Past Week Past month. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. 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. Telehealth Guidelines - TriWest 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. 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. Cigna commercial and Cigna Medicare Advantage customers receive the COVID-19 vaccine with no out-of-pocket costs; and. However, facilities will not be penalized financially for failure to notify us of admissions. Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. 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. 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.). However, this added functionality is planned for a future update. 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. For all Optum Behavioral Health commercial plans, any telehealth services provided via a real-time audio and video communication system can be billed for members at home or another location. A facility maintained by either State or local health departments that provides ambulatory primary medical care under the general direction of a physician. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. 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. Please visit CignaforHCP.com/virtualcare for additional information about that policy. Yes. The provider will need to code appropriately to indicate COVID-19 related services. As a reminder, standard customer cost-share applies for non-COVID-19 related services. Please visit. Clarifying Codes G0463 and Q3014: Hospital Billing for - Vitalware Treatment is supportive only and focused on symptom relief. No. Telehealth Place of Service Code & Other U.S. Telehealth Policy Updates PDF FAQs for Illinois Medicaid Virtual Healthcare Expansion/Telehealth 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. 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. The POS Workgroup is revising the description of POS code 02 and creating a new POS code 10 to meet the overall industry needs, as follows: 1. Maybe. More information about coronavirus waivers and flexibilities is available on . Note that billing B97.29 will not waive cost-share. When an order for home health services is clinically appropriate for telehealth services, the care will be offered through a virtual visit unless the order indicates that home health services must be in-person or the patient refuses the virtual visit. Whether physicians report the audio-only encounter to a private payer as an office visit (99201-99215) or telephone E/M service (99441-99443) will depend on what the physician is able to document . 2. identify telehealth or telephone (audio only) services that were historically performed in the office or other in person setting (E.g.