Recent guidelines have recommended keeping the normal service facility that you are registered under in your CMS-1500. Routine and non-emergent transfers to a secondary facility continue to require authorization. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. As of July 1, 2022, we request that providers bill with POS 02 for all virtual care. that insure or administer group HMO, dental HMO, and other products or services in your state). Until further notice, we will continue to made additional virtual care accommodations by allowing: eConsults are when a treating health care provider seeks guidance from a specialist physician through electronic means (e.g., phone, Internet, EHR consultation) to help manage care that is beyond the treating health care provider's usual practice.Typical examples include: Yes. No. In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. 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 (when billed on the same or different claims). As of April 1, 2021, Cigna resumed standard authorization requirements. Please review the "Virtual care services" frequently asked questions section on this page for more information. For costs and details of coverage, review your plan documents or contact a Cigna representative. .gov 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. M misstigris Networker Messages 63 Location Portland, OR 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. Diagnoses requiring testing cannot be confirmed. No. Place of Service (POS) equal to what it would have been had the service been provided in-person. Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. Cigna will cover the administration of the COVID-19 vaccine with no customer cost-share even when administered by a non-participating provider following the guidance above. Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication). 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. Yes. This eases coordination of benefits and gives other payers the setting information they need. 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. 24/7, live and on-demand for a variety of minor health care questions and concerns. Product availability may vary by location and plan type and is subject to change. As long as one of these modifiers is included for the appropriate procedure code(s), the service will be considered to have been performed virtually. 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. While services billed on a UB-04 are out of scope for the new policy, we will continue to evaluate facility-based services for future policy updates. As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. 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. Telehealth can provide many benefits for your practice and your patients, including increased 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. 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. 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. One of our key goals is to help your patients connect to affordable, predictable, and convenient care anytime, anywhere. 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. Cigna will determine coverage for each test based on the specific code(s) the provider bills. Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. (Effective January 1, 2016). In certain cases, yes. Please visit. 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. As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. No. 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. Denny has interviewed hundreds of mental health practitioners to better understand their struggles and solutions, all with the goal of making the professional side of behavioral health a little easier, faster, and less expensive. Cigna does require prior authorization for fixed wing air ambulance transport. (This code is available for use immediately with a final effective date of May 1, 2010), A location, not described by any other POS code, owned or operated by a public or private entity where the patient is employed, and where a health professional provides on-going or episodic occupational medical, therapeutic or rehabilitative services to the individual. Telehealth (also referred to as telemedicine) gives our members access to their health care provider from their home or another location. Codes 99441-99443 are non-face-to-face E/M services provided to a patient using the telephone by a physician or other QHP who may report E/M services. The test is FDA approved or cleared or have received Emergency Use Authorization (EUA); The test is run in a laboratory, office, urgent care center, emergency room, drive-thru testing site, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU. 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). Please visit CignaforHCP.com/virtualcare for additional information about that policy. We also continue to make several additional accommodations related to virtual care until further notice. 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. Additionally, when you bill POS 02, your patients may also pay a lower cost-share for the virtual services they receive due to a recent change in some plan benefits. The site is secure. As of July 1, 2022, standard credentialing timelines again apply. Prior to the COVID-19 PHE, the patient's place of service was indicated with code 02, which previously indicated all telehealth patient sites. A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services rendered by, or under the supervision of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients. Talk directly to board-certified providers 24/7 by video or phone for help with minor, non-life-threatening medical conditions1. 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. We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice. Cigna commercial and Cigna Medicare Advantage will not directly reimburse claims submitted under the medical benefit by retailers or by health care providers like hospitals, urgent care centers, and primary care groups for OTC COVID-19 tests, including when billed with CPT code K1034. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. lock 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). Customers will be referred to seek in-person care. 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. 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. POS 11, 19 and 22) modifier GT or 95 (or GQ for Medicaid) must be used. The U.S. Food and Drug Administration (FDA) recently approved for emergency use two prescription medications for the treatment of COVID-19: PaxlovidTM (from Pfizer) and molnupiravir (from Merck). 1 In an emergency, always dial 911 or visit the nearest hospital. 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. The COVID-19 billing and reimbursement guidelines that follow are for commercial Cigna medical services, including IFP, unless otherwise noted. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other . 1995-2020 by the American Academy of Orthopaedic Surgeons. 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. 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. Thanks for your help! Therefore, we will not enforce an administrative denial for failure to secure authorization (FTSA)on appeal if an extenuating circumstance due to COVID-19 applied. You free me to focus on the work I love!. 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. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. Please review our R33 COVID-19 Interim Billing Guidelines policy for ICD-10 diagnosis code requirements to have cost-share waived for G2012. These codes do not need a place of service (POS) 02 or modifier 95 or GT. These codes are used to report episodes of patient care initiated by an established patient or guardian of an established patient. 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. Virtual care offered by Urgent Care Centers billing with code S9083 is reimbursable until further notice. 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. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Per CMS, individuals without health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost. 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. 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. 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. Urgent Care vs. the Emergency Room7 Ways to Help Pay Less for Out-of-Pocket Costs, What is Preventive Care?View all articles. Yes. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? Providers should bill this code for dates of service on or after December 23, 2021. A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. Most mental health providers will be furnishing services using Place of Service code 10 (POS 10) when providing telehealth services. Please review these changes by going to the Provider FastFax page and selecting fax number 30. 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. Yes. 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. 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). Total 0 Results. Telehealth services not billed with 02 will be denied by the payer. As of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. 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. 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. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. A facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on a 24-hour basis, by or under the supervision of a physician. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. Download and . Please note that this list is not all inclusive and may not represent an exact indication match. For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. Sign up to get the latest information about your choice of CMS topics. 5 Virtual dermatological visits through MDLIVE are completed via asynchronous messaging. Below is a definition of POS 02 and POS 10 for CMS-1500 forms, alongside a list of major insurance brands and their changes. 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. New/Modifications to the Place of Service (POS) Codes for Telehealth. Service performed: OEce or other outpatient visit for the evaluation and management of a new patient CPT code billed: 99202 Modier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): 100% of face-to-face rate Customer cost-share: Applies consistent with Yes. A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician's office. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP).
