), Preventive care services (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) [Effective with January 29, 2022 dates of service]. Talk directly to board-certified providers 24/7 by video or phone for help with minor, non-life-threatening medical conditions1. Washington, D.C. 20201 Outpatient E&M codes for new and established patients (99202-99215) Physical and occupational therapy E&M codes (97161-97168) Telephone-only E&M codes (99441-99443) Annual wellness visit codes (G0438 and G0439) For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. Provider: Telehealth Medicare Risk Adjustment - Humana 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. While the R31 Virtual Care Reimbursement Policy that went into effect on January 1, 2021 only applies to claims submitted on a CMS-1500 claim form, we will continue to reimburse virtual care services billed on a UB-04 claim form until further notice when the services: Please note that existing reimbursement policies will apply and may affect claims payment (e.g., R30 E&M Services). Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. 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. When no specific contracted rates are in place, Cigna will reimburse covered services at the established national CMS rates to ensure timely, consistent, and reasonable reimbursement. 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. Telemedicine Billing Manual - Colorado Cigna allows modifiers GQ, GT, or 95 to indicate virtual care for all services. 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. Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; Yes. Toll Free Call Center: 1-877-696-6775. 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. 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. When no specific contracted rates are in place, Cigna will reimburse the administration of all emergency use authorized (EUA) vaccines at the established national, Cigna will reimburse vaccinations administered in a home setting an additional $35.50 per dose consistent with the established national. No. In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. When no specific contracted rates are in place, Cigna will reimburse the administration of all covered COVID-19 vaccines at the established national CMS rates noted below when claims are billed under the medical benefit to ensure timely, consistent, and reasonable reimbursement. Listed below are place of service codes and descriptions. Telehealth Resources | Providers | Excellus BlueCross BlueShield Reimbursement for codes that are typically billed include: Yes. CHCP - Resources - Virtual Care - Cigna Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF). Instead U07.1, J12.82, M35.81, or M35.89 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnoses.Please refer to the general billing guidance for additional information. 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. For more information, please visit Cigna.com/Coronavirus. 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. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. 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. Place of Service 02 in Field 24-B (see sample claim form below) For illustrative purposes only. We also referenced the current list of covered virtual care codes by the CMS to help inform our coverage strategy. To receive payment equivalent to a normal face-to-face visit you will not bill POS 2 and instead will follow Medicare guidance to bill POS 11 as if care was delivered in the office during COVID-19. 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. We maintain all current medical necessity review criteria for virtual care at this time. Note: This article was updated on January 26, 2022, for clarification purposes. Thanks for your help! Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. When administered consistently with Cigna's Drug and Biologics policy and EUA usage guidelines, Cigna will reimburse the infusion and post-administration monitoring of the listed treatments at contracted rates when specific contracted rates are in place for COVID-19 services. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. The .gov means its official. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. 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). As of February 16, 2021 dates of service, these treatments remain covered, but with standard customer cost-share. The POS Workgroup is revising the description of POS code 02 and creating a new POS code 10 to meet the overall industry needs, as follows: 1. You free me to focus on the work I love!. 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). 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. 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 has not lifted precertification requirements for scheduled surgeries. A short term accommodation such as a hotel, camp ground, hostel, cruise ship or resort where the patient receives care, and which is not identified by any other POS code. For covered virtual care services cost-share will apply as follows: No. Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. The Administration's plan is to end the COVID-19 public health emergency (PHE) on May 11, 2023. Services include methadone and other forms of Medication Assisted Treatment (MAT). 31, 2022. 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. . 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. . Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. However, facilities will not be penalized financially for failure to notify us of admissions. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. Cigna continues to require prior authorization reviews for routine advanced imaging. 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 additional credentialing or notification to Cigna is required. Specimen collection centers like these can also bill codes G2023 or G2024 following the preceding guidance. AAOS Login - American Academy of Orthopaedic Surgeons Yes. 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. We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. (Effective January 1, 2016). 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). Cigna will factor in the current strain on health care systems and will incorporate this information into retrospective reviews. Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. 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, Most synchronous technology to be used (e.g., FaceTime, Skype, Zoom, etc. (Effective January 1, 2003), A facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to tribal members who do not require hospitalization. New/Modifications to the Place of Service (POS) Codes for Telehealth Inpatient COVID-19 care that began on or before February 15, 2021, and continued on or after February 16, 2021 at the same facility, will have cost-share waived for the entire course of the facility stay. 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.