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. Treatment is supportive only and focused on symptom relief. For a complete list of billing requirements, please review the Virtual Care Reimbursement Policy. ( PDF COVID-19 MEDICARE ADVANTAGE BILLING & AUTHORIZATION GUIDELINES - Cigna 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. Telehealth Reimbursement Alert: 2022 Telehealth CPT Codes Released We also continue to make several other accommodations related to virtual care until further notice. 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. 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. 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. (99441, 98966, 99442, 98967, 99334, 98968). As always, we remain committed to ensuring that: Yes. Yes. A freestanding facility, other than a physician's office, where surgical and diagnostic services are provided on an ambulatory basis. As of April 1, 2021, Cigna resumed standard authorization requirements. We covered codes 99441-99443 as part of these interim COVID-19 guidelines, and continue to cover them as part of the R31 Virtual Care Reimbursement Policy. PDF FAQs for Illinois Medicaid Virtual Healthcare Expansion/Telehealth Specialist to specialist (e.g., ophthalmologist requesting consultation from a retina specialist, orthopedic surgeon requesting consultation from an orthopedic surgeon oncologist, cardiologist with an electrophysiology cardiologist, and obstetrician from a maternal fetal medicine specialist), Hospitalist requests an infectious disease consultation for pulmonary infections to guide antibiotic therapy, The ICD-10 code that represents the primary condition, symptom, or diagnosis as the purpose of the consult; and. Cigna will allow direct emergent or urgent transfers from an acute inpatient facility to a second acute inpatient facility, skilled nursing facility (SNF), acute rehabilitation facility (AR), or long-term acute care hospital (LTACH). No. If an urgent care center performs an evaluation and treatment service, collects a specimen for COVID-19, and runs the laboratory test, they should bill just their per-visit S9083 code or just the laboratory code. Cigna remains adequately staffed to respond to all new precertification requests for elective procedures within our typical timelines. Throughout the pandemic, the emergency use authorized monoclonal antibody drug bebtelovimab was purchased by the federal government and offered to providers for free. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. If antibodies are present, it means that individual previously had a specific viral or bacterial infection - like COVID-19. 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. Through December 31, 2020 dates of service, providers could deliver virtual neuropsychological and psychological testing services and bill their regular face-to-face CPT codes that were on their fee schedule . We do not expect smaller laboratories or doctors' offices to be able to perform these tests. 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. Please review the Virtual care services frequently asked questions section on this page for more information. billing for phone "visit" | Medical Billing and Coding Forum - AAPC all continue to be appropriate to use at this time. Ten Things To Know Before Billing CPT 99490 - ChartSpan Per usual protocol, emergency and inpatient imaging services do not require prior authorization. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. Consistent with federal guidelines for private insurers, Cigna commercial will cover up to eight over-the-counter (OTC) diagnostic COVID-19 tests per month (per enrolled individual) with no out-of-pocket costs for claims submitted by a customer under their medical benefit. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). To sign up for updates or to access your subscriber preferences, please enter your contact information below. In addition, the discharging provider or primary care physician can provide the post discharge visit virtually if appropriate. Instead, we request that providers bill POS 02 for all virtual care in support of the new client benefit plan option that lowers cost-share for certain customers who receive virtual care. 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. Per CMS, U0003 and U0004 should be used to bill for tests that would typically be billed by 87635 and U0002 respectively, except for when the tests are performed with these high-throughput technologies. Providers should bill the relevant vaccine administration code (e.g., 0001A, 0002A, etc.) bill a typical face-to-face place of service (e.g., POS 11) . 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. Our newest Playbook in the series focuses on the implementation of telehealth (PDF), defined as real-time, audio-visual visits between a clinician and patient. 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. "Medicare hasn't identified a need for new POS code 10. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. Cigna Telehealth Place Of Service - family-medical.net No. ICD-10 code U07.1, J12.82, M35.81, or M35.89. Secure .gov websites use HTTPSA A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. A portion of a hospitals main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. ), 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). We hope you join us in our journey to offer our customers increased access to virtual care and appreciate your commitment to work with us as our virtual care platform continues to evolve to the meet the needs of our providers, customers, and clients. Cigna Telehealth Service A facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program for patients who do not require full time hospitalization, but who need broader programs than are possible from outpatient visits to a hospital-based or hospital-affiliated facility. As a reminder, standard customer cost-share applies for non-COVID-19 related services. eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. If the patient is in their home, use "10". 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. 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. We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice. 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. We recommend providers bill POS 02 beginning July 1, 2022 for virtual services (instead of a face-to-face POS). Billing and coding Medicare Fee-for-Service claims - Telehealth.HHS.gov (Effective January 1, 2016). Providers that receive the COVID-19 vaccine free of charge from the federal government are prohibited from seeking reimbursement from consumers for vaccine administration costs whether as cost sharing or balance billing. State and federal mandates, as well as customer benefit plan designs, may supersede our guidelines. PDF New/Modifications to the Place of Service (POS) Codes for Telehealth Other Reimbursement Type. There are two primary types of tests for COVID-19: A serology (i.e., antibody) test for COVID-19 is considered diagnostic and covered without cost-share through at least May 11, 2023 when ALL of the following criteria are met: When specific contracted rates are in place for diagnostic COVID-19 serology tests, Cigna will reimburse covered services at those contracted rates. Yes. POS 02: Telehealth Provided Other than in Patient's Home 4 Due to state laws governing teledentistry, this service is not available to residents of Texas. The site is secure. As of July 1, 2022, standard credentialing timelines again apply. No. 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. Providers should bill this code for dates of service on or after December 23, 2021. The interim COVID-19 virtual care guidelines were solely in place through December 31, 2020, and this new policy took effect on January 1, 2022. 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. Services not related to COVID-19 will have standard customer cost-share. Claims were not denied due to lack of referrals for these services during that time. representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). If a provider typically delivered face-to-face services in a facility setting, that provider could also deliver any appropriate service virtually consistent with existing Cigna policies through December 31, 2020 dates of service. Yes. Locations may have included hospitals, rehabilitation centers, skilled nursing facilities, temporary hospitals, or any other facility where treatment is generally provided.