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. Maybe. COVID-19 Reimbursement Guidelines - Provider Express Cigna may request the appropriate CLIA-certification or waiver as well as the manufacturer and name of the test being performed. 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). 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. A certified facility which is located in a rural medically underserved area that provides ambulatory primary medical care under the general direction of a physician. Providers should bill the relevant vaccine administration code (e.g., 0001A, 0002A, etc.) Cost-share will be waived for COVID-19 related services only when providers bill the appropriate ICD-10 code and modifier CS. We will continue to monitor inpatient stays. Codes on the list of approved telehealth services allow for various settings, but there must be both audio and video in real time between the physician . Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. List the address of the physician for the telehealth visit on the CMS1500 claim. Cigna follows CMS rules related to the use of modifiers. Yes. Telemedicine Billing Tips - Capture Billing - Medical Billing Company Cigna will cover Evusheld when administered for the prevention of COVID-19 in certain adults and pediatric individuals consistent with FDA EUA guidance and Cigna's Drug and Biologics Coverage Policy, effective with dates of service on and after December 8, 2021.Please note that Cigna does not require prior authorization for the use or administration of Evusheld. Talk to board-certified dermatologists without an appointment for customized care for skin, hair, and nail conditions. Yes. Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. A serology test is a blood test that measures antibodies. When specific contracted rates are in place for diagnostic COVID-19 lab tests, Cigna will reimburse covered services at those contracted rates. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 Yes. 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 specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. These include: Virtual preventive care, routine care, and specialist referrals. 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. PDF INTERIM TELEHEALTH GUIDANCE - Integrated Health Care 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. Per usual policy, Cigna does not require three days of inpatient care prior to transfer to a SNF. 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. Introduction and Overview - Massachusetts You'll always be able to get in touch. However, this added functionality is planned for a future update. 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. 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 home facility (place of service 32), or to an individuals home (place of service 12) to collect the specimen. Cigna will reimburse providers the full allowed amount of the claim, including what would have been the customer's cost share. Please note that all technology used must be secure and meet or exceed federal and state privacy requirements. Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication). 2. A location where providers administer pneumococcal pneumonia and influenza virus vaccinations and submit these services as electronic media claims, paper claims, or using the roster billing method. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. However, facilities will not be penalized financially for failure to notify us of admissions. In addition, the discharging provider or primary care physician can provide the post discharge visit virtually if appropriate. "All Rights Reserved." This website and its contents may not be reproduced in whole or in part without . 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. Claims must be submitted on a CMS-1500 form or electronic equivalent. They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. Effective for dates of service on and after January 1, 2021, we implemented a new R31 Virtual Care Reimbursement Policy. Providers could deliver any face-to-face service on their fee schedule virtually, including those not related to COVID-19, for dates of service through December 31, 2020. As of July 1, 2022, we request that providers bill with POS 02 for all virtual care. Telemedicine Billing Guide & CPT Codes | HealthLens Modifier CR and condition code DR can also be billed instead of CS. Urgent care centers can also bill their typical S9083 code for services that are more complex than a quick telephone call. As always, we remain committed to providing further updates as soon as they become available. Cigna covers C9803 with no customer cost-share for a hospital outpatient clinic visit specimen collection, including drive-thru tests, through at least May 11, 2023 only when billed without any other codes. This includes providers who typically deliver services in a facility setting. Throughout the pandemic, the emergency use authorized monoclonal antibody drug bebtelovimab was purchased by the federal government and offered to providers for free. I cannot capture in words the value to me of TheraThink. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. The codes should not be billed if the sole purpose of the consultation is to arrange a transfer of care or a face-to-face visit. 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). Yes. A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. Diluents are not separately reimbursable in addition to the administration code for the infusion. On July 2, 2021 MVP announced changes to member cost-share effective August 1, 2021. Place of Service Codes Updated for Telehealth, though Not for Medicare A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. 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. Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. Diluents are not separately reimbursable in addition to the administration code for the infusion. The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place at least until the end of Public Health Emergency (PHE) period. DISCLAIMER: The contents of this database lack the force and effect of law, except as All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02. Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; Depending on your plan and location, you can connect with board-certified medical providers, dentists, and licensed therapists online using a phone, tablet, or computer. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. POS 02: Telehealth Provided Other than in Patient's Home No. PDF Optum Behavioral Health: COVID-19 updates to telehealth policies Please note that our interim COVID-19 virtual care guidelines were in place until December 31, 2020. Place of Service 02 in Field 24-B (see sample claim form below) For illustrative purposes only. A facility that provides the following services: outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically ill, and residents of the CMHC's mental health services area who have been discharged from inpatient treatment at a mental health facility; 24 hour a day emergency care services; day treatment, other partial hospitalization services, or psychosocial rehabilitation services; screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission; and consultation and education services. When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance. Telehealth Place of Service Code: Telehealth Reimbursement 1 Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually until further notice. Yes. Download and . Unless telehealth requirements are . All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of North Carolina, Inc. and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates ( see