Therefore, to increase convenient 24/7 access to care if a customers preferred provider is unavailable in-person or virtually, covered virtual care is also available through national virtual care vendors like MDLive. Please note that Cigna temporarily increased the precertification approval window for all elective inpatient and outpatient services - including advanced imaging - from three months to six months for dates of authorization beginning March 25, 2020 through March 31, 2021. Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. Ultimately however, care must be medically necessary to be covered. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. ), but the patient is also tested for COVID-19 for diagnostic reasons, the provider should bill the diagnosis code specific to the primary reason for the encounter in the first position, and the COVID-19 diagnosis code in any position after the first. This policy applied to customers in the United States who are covered under Cigna's employer/union sponsored insured group health plans, insured plans for US-based globally mobile individuals, Medicare Advantage, and Individual and Family Plans (IFP). 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 or pharmacy. were all appropriate to use). Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. Yes. PDF Optum Behavioral Health: COVID-19 updates to telehealth policies Cigna will generally not cover molecular, antigen, or antibody tests for asymptomatic individuals 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. MLN Matters article MM12549, CY2022 telehealth update Medicare physician fee schedule. My daily insurance billing time now is less than five minutes for a full day of appointments. To speak with a dentist,log in to myCigna. Effective for dates of service on and after January 1, 2021, we implemented a new R31 Virtual Care Reimbursement Policy. Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF). 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. Important notes: For additional information about Cigna's coverage of medically necessary diagnostic COVID-19 tests, please review the COVID-19 In Vitro Diagnostic Testing coverage policy. 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. Cigna remains adequately staffed to respond to all new precertification requests for elective procedures within our typical timelines. NOTE: Please direct questions related to billing place of service codes to your Medicare Administrative Contractor (MAC) for assistance. 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 wanted to implement a policy that ensures you can continue to receive ongoing reimbursement for virtual care that you deliver to your patients with Cigna commercial medical coverage. At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. 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. M0222 (administration in facility setting): $350.50, M0223 (administration in home setting): $550.50. What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? The additional 365 days added to the regular timely filing period will continue through the end of the Outbreak Period, defined as the period of the National Emergency (which is declared by the President and must be renewed annually) plus 60 days. When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance. For covered virtual care services cost-share will apply as follows: No. New/Modifications to the Place of Service (POS) Codes for Telehealth Modifier 95, GT, or GQ must be appended to the virtual care code(s). 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. Concurrent review will start the next business day with no retrospective denials. This will allow for quick telephonic consultations related to COVID-19 screening or other necessary consults, and will offer appropriate reimbursement to providers for this amount of time. The Administration's plan is to end the COVID-19 public health emergency (PHE) on May 11, 2023. We also continue to make several other accommodations related to virtual care until further notice. Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication). Telemedicine Billing Manual - Colorado While we will reimburse these services consistent with face-to-face rates, we will monitor the use of level four and five services to limit fraud, waste, and abuse. Cigna will accept roster billing from providers who are already mass immunizers and bill Cigna today in this way for other vaccines (e.g., seasonal flu vaccine), as well as from providers and state agencies that are offering mass vaccinations for their local communities, provided the claim roster includes sufficient information to identify the Cigna customer. A facility whose primary purpose is education. When no contracted rates are in place, Cigna will reimburse covered diagnostic serology laboratory tests consistent with CMS reimbursement, including $42.13 for code 86769 and $45.23 for code 86328, to ensure consistent, timely, and reasonable reimbursement. (Effective January 1, 2016). 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. Every provider we work with is assigned an admin as a point of contact. a listing of the legal entities This coverage began January 15, 2022 and continues through at least the end of the public health emergency (PHE) period (May 11, 2023). Yes. Cigna does not require prior authorization for home health services. While we will not reimburse the drug itself when a health care provider receives it free of charge, we request that providers bill the drug on the claim using the CMS code for the specific drug (e.g., Q0243 for Casirivimab and Imdevimab), along with a nominal charge (e.g., $.01). We are actively reviewing all COVID-19 state mandates and will continue to share any changes and more details around coverage, reimbursement, and cost-share as applicable. U.S. Department of Health & Human Services When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. POS 10 Telehealth provided in a patient's home was created for services provided remotely to a patient in their private residence. . Telehealth can provide many benefits for your practice and your patients, including increased These codes are used to report episodes of patient care initiated by an established patient or guardian of an established patient. An official website of the United States government Antibody tests: 86328, 86769, 86408, 86409, 86413, and 0224U, Cigna covers diagnostic molecular and antigen tests for COVID-19 through at least. In these cases, the provider should bill as normal on a UB-04 claim form with the appropriate revenue code and procedure code, and also append the GQ, GT, or 95 modifier. ICD-10 code U07.1, J12.82, M35.81, or M35.89. Certain home health services can be provided virtually using synchronous communication as part of our R31 Virtual Care Reimbursement Policy. Cigna will determine coverage for each test based on the specific code(s) the provider bills. Emergent transport to nearby facilities capable of treating customers is covered without prior authorization. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing. Yes. It's our goal to ensure you simply don't have to spend unncessary time on your billing. A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board. As of April 4, 2022, individuals with Medicare Part B and Medicare Advantage plans can get up to eight OTC tests per calendar month from participating pharmacies and health care providers for the duration of the COVID-19 public health emergency (PHE). 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 Ten Things To Know Before Billing CPT 99490 - ChartSpan Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. On July 2, 2021 MVP announced changes to member cost-share effective August 1, 2021. Claims must be submitted on a CMS-1500 form or electronic equivalent. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. The Department may not cite, use, or rely on any guidance that is not posted Reimbursement for codes that are typically billed include: Yes. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). Cigna Telehealth Place of Service Code: 02 Cigna Telehealth CPT Code Modifier: 95 We charge a percentage of the allowed amount per paid claim (only paid claims) No per claim submission fee No annual or monthly subscription fee Place of Service Codes Updated for Telehealth, though Not for Medicare The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. If a provider was reimbursed for a face-to-face service per their existing fee schedule, then they were reimbursed the same amount even if they delivered the service virtually. We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice. .gov You'll always be able to get in touch. Cigna's Virtual Care (Telehealth) Services - Global Health Service Company No virtual care modifier is needed given that the code defines the service as an eConsult. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. A facility which primarily provides to residents skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care services above the level of custodial care to other than individuals with intellectual disabilities. Billing the appropriate administration code will ensure that cost-share is waived. This new initiative enables payment from original Medicare for submitted claims directly to participating eligible pharmacies and other health care providers, which allows Medicare beneficiaries to receive tests at no cost. Similar to non-diagnostic COVID-19 testing services, Cigna will only cover non-diagnostic return-to-work virtual care services when covered by the client benefit plan. 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. Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004.