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. 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. TheraThink.com 2023. Except for the telephone-only codes (99441-99443), all services must be interactive and use both audio and video internet-based technologies (synchronous communication) in order to be covered. 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 Informing Cigna prior to delivering services in other states can help to ensure claims are adjudicated correctly when submitted with addresses in states other than the provider's usual location. 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. Yes. "All Rights Reserved." This website and its contents may not be reproduced in whole or in part without . We will continue to assess the situation and adjust to market needs as necessary. To sign up for updates or to access your subscriber preferences, please enter your contact information below. 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. 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. Location, other than a hospital or other facility, where the patient receives care in a private residence. Once completed, telehealth will be added to your Cigna specialty. All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02. Yes. Through this feedback and research, we developed a list of covered services that we believe are most appropriate to be offered virtually across multiple specialties. Cigna will not make any requirements as it relates to virtual services being for a new or existing patient. When billing for the service, indicate the place of service as where the visit would have occurred if in person. Diagnoses requiring testing cannot be confirmed. In order to bill these codes, the test must be FDA approved or cleared or have received Emergency Use Authorization (EUA). 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. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. Yes. One of our key goals is to help customers connect to affordable, predictable, and convenient care anytime, anywhere. 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). The codes may only be billed once in a seven day time period. Yes. eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). Telehealth services not billed with 02 will be denied by the payer. Yes. Emotional health resources have been added to the COVID-19 interim guidance page for behavioral providers at CignaforHCP.com. 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). Additionally, Cigna understands the tremendous pressure our health care delivery systems are under and will factor in the current strain on health care systems and incorporate this information into retrospective coverage reviews. Cigna will waive all customer cost-share for diagnostic services, testing, and treatment related to COVID-19, as follows: The visit will be covered without customer cost-share if the provider determines that the visit was consistent with COVID-19 diagnostic purposes. 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. **, Watch this short video to learn more about virtual care with MDLivefor Cigna.(Length: 00:01:33). However, providers are required to attest that their designated specialty meets the requirements of Cigna. lock 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. 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. In these cases, the provider should bill as normal on a UB-04 claim form with the appropriate revenue code and procedure code, and also append the GQ, GT, or 95 modifier. A facility or location where drugs and other medically related items and services are sold, dispensed, or otherwise provided directly to patients. Place of Service Code Set. Yes. Standard cost-share will apply for the customer, unless waived by state-specific requirements. 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. Urgent care centers can also bill their typical S9083 code for services that are more complex than a quick telephone call. 4 Due to state laws governing teledentistry, this service is not available to residents of Texas. Must be performed by a licensed provider. Diluents are not separately reimbursable in addition to the administration code for the infusion. Place of Service 02 in Field 24-B (see sample claim form below) For illustrative purposes only. Note: This article was updated on January 26, 2022, for clarification purposes. All Time (0 Recipes) Past 24 Hours Past Week Past month. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. ), but the patient is also tested for COVID-19 for diagnostic reasons, the provider should bill the diagnosis code specific to the primary reason for the encounter in the first position, and the COVID-19 diagnosis code in any position after the first. Please note that some opt-outs for self-funded benefit plans may have applied. new codes. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. Most mental health providers will be furnishing services using Place of Service code 10 (POS 10) when providing telehealth services. If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice. However, Cigna will still consider requestes for accelerated credentialing on a case-by-case basis. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). Yes. Toll Free Call Center: 1-877-696-6775. 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. 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. Recently, the Centers for Medicare & Medicaid Services (CMS) introduced a new place-of-service (POS) code and revised another POS code in an effort to improve the reporting of telehealth services provided to patients at home as well as the coverage of telebehavioral health. Unlisted, unspecified and nonspecific codes should be avoided. 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). No. 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 . Usually not. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 Cigna will only reimburse claims for covered OTC COVID-19 tests submitted by customers under their medical benefit and by certain pharmacy retailers under the pharmacy benefit, as elected by clients. https:// The location where health services and health related services are provided or received, through telecommunication technology. While the policy - announced in United's . 5 Virtual dermatological visits through MDLIVE are completed via asynchronous messaging. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. We recommend providers bill POS 02 beginning July 1, 2022 for virtual services (instead of a face-to-face POS). Providers can call Cigna customer service at 1.800.88Cigna (882.4462) to check a patients eligibility information, including if their plan offers coverage for these purposes. . Ultimately however, care must be medically necessary to be covered. As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. 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. Providers should bill one of the above codes, along with: No. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. Cigna remains adequately staffed to respond to all new precertification requests for elective procedures within our typical timelines. Let us handle handle your insurance billing so you can focus on your practice. Effective January 1, 2021, we implemented a new. For telehealth, the 95 modifier code is used as well. Recent guidelines have recommended keeping the normal service facility that you are registered under in your CMS-1500. Deliver services that are covered by the Virtual Care Reimbursement Policy; Bill consistently with the requirements of the policy; and. Yes. This is true for Medicare or other insurance carriers. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Cigna commercial and Cigna Medicare Advantage customers receive the COVID-19 vaccine with no out-of-pocket costs; and. 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. If a provider was reimbursed for a face-to-face service per their existing fee schedule, then they were reimbursed the same amount even if they delivered the service virtually. Previously, these codes were reimbursable as part of our interim COVID-19 accommodations. Providers should append the GQ, GT, or 95 modifier and Cigna will reimburse them consistent with their face-to-face rates. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. 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. A medical facility operated by one or more of the Uniformed Services. Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004. 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. And as customers seek more convenient and safe care options, we continue to see growing interest in virtual care (i.e., telehealth) especially from consumers and their providers who want to ensure they have greater access and connection to each other. Cigna covers FDA EUA-approved laboratory tests. 200 Independence Avenue, S.W. While we encourage PT/OT/ST providers to follow CMS guidance regarding the use of software programs for virtual care, we are not requiring the use of any specific software program at this time. 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.
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