DISCLAIMER: The contents of this database lack the force and effect of law, except as Cigna remains adequately staffed to respond to all new precertification requests for elective procedures within our typical timelines. Yes. Cigna will determine coverage for each test based on the specific code(s) the provider bills. If a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. "All Rights Reserved." This website and its contents may not be reproduced in whole or in part without . This coverage began January 15, 2022 and continues through at least the end of the public health emergency (PHE) period (May 11, 2023). Urgent care centers can also bill their typical S9083 code for services that are more complex than a quick telephone call. No additional modifiers are necessary to include on the claim. An official website of the United States government. 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. Emergent transport to nearby facilities capable of treating customers is covered without prior authorization. You want to get paid quickly, in full, and not have to do more than spend 10 or 15 minutes to input your weekly calendar. A facility other than a hospital, which provides dialysis treatment, maintenance, and/or training to patients or caregivers on an ambulatory or home-care basis. The site is secure. Paid per contract; standard cost-share applies. All Rights Reserved. Yes. First Page. Standard customer cost-share applies. Talk privately with a licensed therapist or psychiatrist by appointment using your phone, tablet, or computer. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. Under My Account > Settings > Practice Details, you can select the Insurance Place of Service code associated with sessions held via video. No virtual care modifier is needed given that the code defines the service as an eConsult. For additional information about our coverage of the COVID-19 vaccine, please review our. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. No additional credentialing or notification to Cigna is required. MLN Matters article MM7631, Revised and clarified place of service (POS) coding instructions. Urgent care centers can bill their global S code when a significant and separately identifiable service is performed at the same time as the administration of the vaccine, but will only be reimbursed for both services when their contract allows it (similar to how they may be reimbursed today for flu shot administration). Cigna will only cover non-diagnostic PCR, antigen, and serology (i.e., antibody) tests when covered by the client benefit plan. No. Cost-share will be waived for COVID-19 related services only when providers bill the appropriate ICD-10 code and modifier CS. codes and normal billing procedures. A federal government website managed by the In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. Activate your myCigna account nowto get access to a virtual dentist. No. For dates of service April 14, 2020 through at least May 11, 2023, Cigna will cover U0003 and U0004 with no customer cost-share when billed by laboratories using high-throughput technologies as described by CMS. No. No. Therefore, FaceTime, Skype, Zoom, etc. End-Stage Renal Disease Treatment Facility. BCBSNC Telehealth Corporate Reimbursement Policy CIGNA Humana Humana Telehealth Expansion 03/23/2020 Humana provider FAQs Medicaid Special Bulletin #28 03/30/2020 (Supersedes Special Bulletin #9) Medicare Telemedicine Provider Fact Sheet 03/17/2020 Medicare Waivers 03.30.2020 PalmettoGBA MLN Connects Special Edition - Tuesday, March 31, 2020 The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. A facility or distinct part of a facility for psychiatric care which provides a total 24-hour therapeutically planned and professionally staffed group living and learning environment. 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. Cigna continues to reimburse participating providers when they are credentialed to practice medicine per state regulations, have a current contract, and have completed the Cigna credentialing process.Non-participating providers will only be reimbursed if: Yes. If you are rendering services as part of a facility (i.e., intensive outpatient program . If specimen collection and a laboratory test are billed together, only the laboratory test will be reimbursed. 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. As of February 16, 2021 dates of service, cost-share applies. 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. Because most standard Cigna client benefit plans do not extend coverage to screening services when performed for employment reasons (e.g., occupational physical examination), virtual care screening services will generally not be covered solely for return-to-work purposes. The Virtual Care Reimbursement Policy also applies to non-participating providers. Cigna Telehealth Place of Service Code: 02. Cigna commercial and Cigna Medicare Advantage will waive the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. 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 Additional information about the COVID-19 vaccines, including planning for a vaccine, vaccine development, getting vaccinated, and vaccine safety can be found on the CDC website. When no specific contracted rates are in place, we will reimburse this code at $22.99 consistent with CMS pricing to ensure consistent, timely, and reasonable reimbursement. 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. Instead, U07.1, J12.82, M35.81, or M35.89 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnosis. Please note that all technology used must be secure and meet or exceed federal and state privacy requirements. Cigna will cover Evusheld when administered for the prevention of COVID-19 in certain adults and pediatric individuals consistent with FDA EUA guidance and Cigna's Drug and Biologics Coverage Policy, effective with dates of service on and after December 8, 2021.Please note that Cigna does not require prior authorization for the use or administration of Evusheld. New/Modifications to the Place of Service (POS) Codes for Telehealth. As private practitioners, our clinical work alone is full-time. 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. These codes should be used on professional claims to specify the entity where service(s) were rendered. This includes providers who typically deliver services in a facility setting. 24/7, live and on-demand for a variety of minor health care questions and concerns. INTERIM TELEHEALTH GUIDANCE Announcement from Cigna Behavioral Health . Other place of service not identified above. . If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice. When billing, you must use the most appropriate code as of the effective date of the submission. 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. In addition, Anthem would recognize telephonic-only . Providers will not need a specific consent from patients to conduct eConsults. (Description change effective January 1, 2016). Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; Cigna covers C9803 with no customer cost-share for a hospital outpatient clinic visit specimen collection, including drive-thru tests, through at least May 11, 2023 only when billed without any other codes. No waiting rooms. 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. 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. Virtual care (also known as telehealth, or telemedicine) is the use of technology to connect with a provider by video or phone using a computer or mobile device. 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 Yes. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. CMS officially has designated a Place of Service code for all of the telehealth to be "02" starting April 1, 2020. The Outbreak Period is a period distinct from the COVID-19 public health emergency (PHE), which applies to other COVID-related relief measures, such as no-cost share coverage of COVID-19 testing. 1 In an emergency, always dial 911 or visit the nearest hospital. 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). When multiple services are billed along with S9083, only S9083 will be reimbursed. 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. For additional information about our Virtual Care Reimbursement Policy, providers can contact their provider representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). Similar to non-diagnostic COVID-19 testing services, Cigna will only cover non-diagnostic return-to-work virtual care services when covered by the client benefit plan. Area (s) of Interest: Payor Issues and Reimbursement. The .gov means its official. Services may be rendered via telemedicine when the service is: A covered Health First Colorado benefit, Within the scope and training of an enrolled provider's license, and; Appropriate to be rendered via telemedicine. Store and forward communications (e.g., email or fax communications) are not reimbursable. 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. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. Approximately 98% of reviews are completed within two business days of submission. Certain client exceptions may apply to this guidance. Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. If the patient is in their home, use "10". Claims must be submitted on a CMS-1500 form or electronic equivalent. 4. COVID-19 admissions would be emergent admissions and do not require prior authorizations. 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). POS 02: Telehealth Provided Other than in Patient's Home All synchronous technology used must be secure and meet or exceed federal and state privacy requirements. 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. ICD-10 diagnosis codes that generally reflect non-covered services are as follows. 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. website belongs to an official government organization in the United States. Please note that HMO and other network referrals remained required through the pandemic, so providers should have continued to follow the normal process that has been in place. 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 a complete list of billing requirements, please review the Virtual Care Reimbursement Policy. You can call, text, or email us about any claim, anytime, and hear back that day. Yes. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. We continue to monitor for any updates from the administration and are evaluating potential changes to our ongoing COVID-19 accommodations as a result of the PHE ending. Cigna covers diagnostic antibody tests when 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). 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. Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. 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). 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. Modifier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): .
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