CMS now defines these two telemedicine place of service (POS) codes: POS 02: Telehealth Provided Other than in Patient's Home Descriptor: The location where health services and health related services are provided or received, through telecommunication technology. 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. Virtual care offered by Urgent Care Centers billing with code S9083 is reimbursable until further notice. Modifier CS for COVID-19 related treatment. We will continue to assess the situation and adjust to market needs as necessary. Know how to bill a facility fee The Center for Medicare and Medicaid Services (CMS) has announced that there is to be a change in the telehealth place of service (POS) code for billing Medicare and Medicaid Services. 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.). 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. ( ), 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. PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. Area (s) of Interest: Payor Issues and Reimbursement. . 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. Yes. Please note that state mandates and customer benefit plans may supersede our guidelines. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours. When specific contracted rates are in place for COVID-19 vaccine administration services, Cigna will reimburse covered services at those contracted rates. Services provided on and after February 16, 2021 remain covered, but with standard customer cost-share.After the EUA or licensure of each COVID-19 treatment by the FDA, CMS will identify the specific drug code(s) along with the specific administration code(s) for each drug that should be billed. Generally, only well-equipped commercial laboratories and hospital-based laboratories will have the necessary equipment to offer these tests. 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 implemented a Virtual Care Reimbursement Policy for commercial medical services, effective January 1, 2021.1 This policy ensures you can continue to receive ongoing reimbursement for virtual care provided to your patients with Cigna commercial medical coverage.2. ** The Benefits of Virtual Care No waiting rooms. 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. Psychiatric Facility-Partial Hospitalization. We are your billing staff here to help. A medical facility operated by one or more of the Uniformed Services. Cigna commercial and Cigna Medicare Advantage will waive the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. Place of Service (POS) equal to what it would have been had the service been provided in-person. Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. Usually not. Yes. 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. The COVID-19 billing and reimbursement guidelines that follow are for commercial Cigna medical services, including IFP, unless otherwise noted. Anthem would recognize IOP services that are rendered via telehealth with a revenue code (905, 906, 912, 913), plus CPT codes for specific behavioral health services. On July 2, 2021 MVP announced changes to member cost-share effective August 1, 2021. on the guidance repository, except to establish historical facts. 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. Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (LINA) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (NYLGICNY) (New York, NY), formerly known as Cigna Life Insurance Company of New York. 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-residential Substance Abuse Treatment Facility, Non-residential Opioid Treatment Facility, A location that provides treatment for opioid use disorder on an ambulatory basis. 4. In 2017, Cigna launched behavioral telehealth sessions for all their members. 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. Yes. Reimbursement, when no specific contracted rates are in place, are as follows: No. Deliver services that are covered by the Virtual Care Reimbursement Policy; Bill consistently with the requirements of the policy; and. 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. 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 Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 ), Preventive care codes (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) (Effective with January 29, 2022 dates of service), A quick 5- to 10-minute telephone conversation between a provider and their patient (G2012), eConsults (99446-99449, 99451, and 99452), Virtual home health services (G0151, G0152, G0153, G0155, G0157, G0158, G0299, G0300, G0493, S9123, S9128, S9129, and S9131). 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). Talk to a licensed dentist via a video call, 24/7/365. Patient is not located in their home when receiving health services or health related services through telecommunication technology. Learn about the medical, dental, pharmacy, behavioral, and voluntary benefits your employer may offer. Primary care physician to specialist requesting input from a cardiologist, psychiatrist, pulmonologist, allergist, dermatologist, surgeon, oncologist, etc. Cigna allowed providers to bill a standard face-to-face visit for all virtual care services, including those not related to COVID-19, through December 31, 2020 dates of service. Home Visit Codes New Patient: 99343 Established Patient: 99349 Place of Service (POS): 12 - Home Office Visit Codes New Patient: 99203 Established Patient: 99213 Place of Service (POS): 11 - Office Telephone Call Codes Established Patient: 99442 Place of Service (POS): 11 - Office Modifiers GQ - Store-and-forward (asynchronous) 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. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. 31, 2022. codes and normal billing procedures. However, facilities will not be penalized financially for failure to notify us of admissions. TheraThink.com 2023. 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. Routine and non-emergent transfers to a secondary facility continue to require authorization. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. 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. My daily insurance billing time now is less than five minutes for a full day of appointments. Please know that we 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. 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. eConsult services remain covered; however, customer cost-share applies as of January 1, 2022. Providers will not need a specific consent from patients to conduct eConsults. 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. The interim COVID-19 virtual care guidelines as outlined on this page were in place for dates of service through December 31, 2020. MLN Matters article MM12549, CY2022 telehealth update Medicare physician fee schedule. In all cases, reimbursement will only be provided for hospital outpatient services performed in a clinic setting (including drive-thru testing sites) when billed on a UB-04 claim form with an appropriate revenue code. To this end, we appreciate the feedback and deep collaboration weve had with provider groups and medical societies regarding virtual care. Last updated February 15, 2023 - Highlighted text indicates updates. No. 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. As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. 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. 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. Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. For services included in our Virtual Care Reimbursement Policy, a number of general requirements must be met for Cigna to consider reimbursement for a virtual care visit. Please note that if the only service rendered is a specimen collection and/or testing, and all of the required components for an evaluation and management (E/M) service code are not met, then only the code for the specimen collection or testing should be billed. 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). Location, distinct from a hospital emergency room, an office, or a clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention. 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. Unlisted, unspecified and nonspecific codes should be avoided. When no contracted rates are in place, Cigna will reimburse covered diagnostic serology laboratory tests consistent with CMS reimbursement, including $42.13 for code 86769 and $45.23 for code 86328, to ensure consistent, timely, and reasonable reimbursement. 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. As of June 1, 2021, these plans again require referrals. One of our key goals is to help customers connect to affordable, predictable, and convenient care anytime, anywhere. For additional information about our Virtual Care Reimbursement Policy, please review the policy, contact your provider representative, or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). Cost-share is waived only when providers bill one of the identified codes. 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. No. These codes are used to report episodes of patient care initiated by an established patient or guardian of an established patient. Mid-level practitioners (e.g., physician assistants and nurse practitioners) can also provide services virtually using the same guidance. We are awaiting further billing instructions for providers, as applicable, from CMS. We will continue to monitor inpatient stays. 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 Specimen collection centers like these can also bill codes G2023 or G2024 following the preceding guidance. Is Face Time allowed? For details, see the CMS document titled Place of Service Codes for Professional Claims Database (updated September 2021). 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. If antibodies are present, it means that individual previously had a specific viral or bacterial infection - like COVID-19. This means that providers could perform services for commercial Cigna medical customers in a virtual setting and bill as though the services were performed face-to-face. In addition, it's my interpretation that Cigna is only paying for telehealth services for physical, occupational and speech therapy submitted on a 1500-claim form by a private practice. 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. 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). We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. 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. M misstigris Networker Messages 63 Location Portland, OR It remains expected that the service billed is reasonable to be provided in a virtual setting. These resources offer access to live-guided relaxation sessions, wellness podcasts, and wellness and stress management flyers. If you are rendering services as part of a facility (i.e., intensive outpatient program . Yes. Comprehensive Inpatient Rehabilitation Facility. When billing telehealth services, healthcare providers must bill the E&M code with place of service code 02 along with a GT or 95 modifier. If more than one telephone, Internet, or electronic health record contact(s) is required to complete the consultation request (e.g., discussion of test results), the entirety of the service and the cumulative discussion and information review time should be billed with a single code. 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 . Below is a definition of POS 02 and POS 10 for CMS-1500 forms, alongside a list of major insurance brands and their changes. Diagnostic tests, which indicate if the individual carries the virus and can infect others, Serology (i.e., antibody) tests, which indicate if the individual had a previous infection and has now potentially developed an immune response, An individual seeks and receives a COVID-19 diagnostic test from a licensed or authorized health care provider; or, A licensed or authorized health care provider refers an individual for a COVID-19 diagnostic test; and, The laboratory test is FDA approved or cleared or has received Emergency Use Authorization (EUA); and, The test is run in a laboratory, office, urgent care center, emergency room, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU; and, The results of a molecular or antigen test are non-diagnostic for COVID-19 and 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); and. Recent guidelines have recommended keeping the normal service facility that you are registered under in your CMS-1500. Billing the appropriate administration code will ensure that cost-share is waived. Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis. No additional modifiers are necessary to include on the claim. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. 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. An official website of the United States government They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. No additional credentialing or notification to Cigna is required. This will allow for quick telephonic consultations related to COVID-19 screening or other necessary consults, and will offer appropriate reimbursement to providers for this amount of time. Telehealth claims with any other POS will not be considered eligible for reimbursement. (Description change effective January 1, 2016). 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. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. In compliance with federal agency guidance, however, Cigna covers individualized COVID-19 diagnostic tests without cost-share through at least May 11, 2023 for asymptomatic individuals when referred by or administered by a health care provider. 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 No. 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. (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.). The location where health services and health related services are provided or received, through telecommunication technology. If specimen collection and a laboratory test are billed together, only the laboratory test will be reimbursed. (Effective January 1, 2016). Yes. However, we believe that FDA and EUA-approved vaccines are safe and effective, and encourage our customers to get vaccinated. Claims were not denied due to lack of referrals for these services during that time. Therefore, please refer to those guidelines for services rendered prior to January 1, 2021. 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. 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. Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. No virtual care modifier is needed given that the code defines the service as an eConsult. Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. Note: We only work with licensed mental health providers. Yes. As the government is providing the initial vaccine doses free of charge to health care providers, Cigna will not reimburse providers for the cost of the vaccine itself. Please review the Virtual care services frequently asked questions section on this page for more information. Cigna has not lifted precertification requirements for scheduled surgeries. Providers administering the vaccine to individuals without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the Provider Relief Fund. Here is a complete list of place of service codes: Place of Service Codes. No. When billing, you must use the most appropriate code as of the effective date of the submission. Precertification (i.e., prior authorization) requirements remain in place. Yes, the cost-share waiver for COVID-19 treatment ended on February 15, 2021. 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. 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. Source: https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf. Yes. 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. To increase convenient 24/7 access to care if a patients preferred provider is unavailable in-person or virtually, our virtual care platform also offers solutions that include national virtual care vendors like MDLive. Comprehensive Outpatient Rehabilitation Facility. 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. 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.