However, facilities will not be penalized financially for failure to notify us of admissions. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other . Providers receive reasonable reimbursement consistent with national CMS rates for administering EUA-approved COVID-19 vaccines. 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. Cigna did not make any requirements regarding the type of technology used for virtual care through December 31, 2020 (i.e., phone, video, FaceTime, Skype, etc. Thank you. Audio-only encounters can be provided using the telephone evaluation and management codes (CPT codes. While as part of this policy, Urgent Care centers billing virtual care on a global S code is not reimbursable, we do continue to reimburse these services until further notice as part of our interim COVID-19 guidelines. Similar to other providers and facilities, urgent care centers should bill just the appropriate COVID-19 vaccine administration code when that is the only service they are providing.Consistent with our reimbursement strategy for all other providers, urgent care centers will be reimbursed for covered vaccine administration services at contracted rates when specific contracted rates are in place for vaccine administration codes. Talk to a licensed dentist via a video call, 24/7/365. We continue to make several other accommodations related to virtual care until further notice. 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. PT/OT/ST providers could deliver virtual care for any service that was on their fee schedule for dates of service through December 31, 2020. Please note that all technology used must be secure and meet or exceed federal and state privacy requirements. 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. for services delivered via telehealth. When a customer receives virtual care services from their regular doctor (or any other provider) as part of this policy and when the provider bills with POS 02 customers with certain benefit plans may have a lower cost-share. 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. No. Add in the unnecessarily difficult insurance billing system and we run the risk of working way over full-time. After the emergency use authorization (EUA) or licensure of each COVID-19 vaccine product by the FDA, CMS will identify the specific vaccine code(s) along with the specific administration code(s) for each vaccine that should be billed. A freestanding facility, other than a physician's office, where surgical and diagnostic services are provided on an ambulatory basis. Additionally, certain virtual care services and accommodations that are not generally reimbursable under the Virtual Care Reimbursement Policy remain reimbursable as part of our continued interim COVID-19 virtual care guidelines until further notice. DISCLAIMER: The contents of this database lack the force and effect of law, except as No additional credentialing or notification to Cigna is required. Yes. 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. Through February 15, 2021, Cigna waived customer cost-share for any approved COVID-19 treatment, no matter the location of the service. My cost is a percentage of what is insurance-approved and its my favorite bill to pay each month! For additional information about our coverage of the COVID-19 vaccine, please review our. End-Stage Renal Disease Treatment Facility. Cost-share is waived when G2012 is billed for COVID-19 related services consistent with our, ICD-10 code Z03.818, Z11.52, Z20.822, or Z20.828, POS 02 and GQ, GT, or 95 modifier for virtual care. While virtual care provided by an urgent care center is not covered per our R31 Virtual Care Reimbursement Policy, we continue to reimburse urgent care centers for delivering virtual care until further notice as part of our interim COVID-19 virtual care accommodations. No. Yes. 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. Yes. For costs and details of coverage, review your plan documents or contact a Cigna representative. 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. Inpatient COVID-19 care that began on or before February 15, 2021, and continued after February 16, 2021, will have cost-share waived for the entire course of the facility stay. Telehealth CPT codes 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (20-30 minutes) Reimbursements match similar in-person services, increasing from about $14-$41 to about $60-$137, retroactive to March 1, 2020 No waiting rooms. 24/7, live and on-demand for a variety of minor health care questions and concerns. As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Specimen collection is not generally paid in addition to other services on the same date of service for the same patient whether billed on the same or different claims by the same provider. 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. 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). When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance. New and revised codes are added to the CPBs as they are updated. 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. Secure .gov websites use HTTPSA * POS code 10 POS code name or 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. . All health insurance policies and health benefit plans contain exclusions and limitations. For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. First Page. Beginning January 15, 2022, and through at least the end of the PHE (. POS 11, 19 and 22) modifier GT or 95 (or GQ for Medicaid) must be used. When the tests are performed for general population or public health surveillance, for employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19, Cigna will generally not cover in-vitro molecular, antigen, or antibody tests for asymptomatic individuals. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. 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. When a state allows an emergent temporary provider licensure, Cigna will allow providers to practice in that state as participating if a provider is already participating with Cigna, is in "good standing," and if state regulations allow such care to take place. Cigna may not control the content or links of non-Cigna websites. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. 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. Cigna covers the administration of the COVID-19 vaccine with no customer-cost share (i.e., no deductible or co-pay) when delivered by any provider. 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. Is Face Time allowed? 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. Considering the pressure facilities are under, Cigna will extend the authorization approval window from three months to six months on request. Emotional health resources have been added to the COVID-19 interim guidance page for behavioral providers at CignaforHCP.com. 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 . No virtual care modifier is needed given that the code defines the service as an eConsult. 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. Services include physical therapy, occupational therapy, and speech pathology services. We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. The provider will need to code appropriately to indicate COVID-19 related services. If an urgent care center administers a quick uniform screening (questionnaire) that does not result in a full evaluation and management service of any level and then performs a COVID-19 test OR a collection service, they should bill only the laboratory code OR collection code. This form can be completed here:https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf. Washington, D.C. 20201 One of our key goals is to help customers connect to affordable, predictable, and convenient care anytime, anywhere. Speak with a provider online and discuss your lab work, biometric screenings. 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. Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. 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. A walk-in health clinic, other than an office, urgent care facility, pharmacy or independent clinic and not described by any other Place of Service code, that is located within a retail operation and provides, on an ambulatory basis, preventive and primary care services. Customers will be referred to seek in-person care. What place of service code should be used for telemedicine services? 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. Below is a definition of POS 02 and POS 10 for CMS-1500 forms, alongside a list of major insurance brands and their changes. *Please Note: virtual check-in and E-visit codes must be billed with Place of Service (POS) 02 and modifier GT.