A residence, with shared living areas, where clients receive supervision and other services such as social and/or behavioral services, custodial service, and minimal services (e.g., medication administration). We will continue to assess the situation and adjust to market needs as necessary. Free Account Setup - we input your data at signup. Cigna waived cost-share for COVID-19 related treatment, in both inpatient and outpatient settings, through February 15, 2021 dates of service. Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. As private practitioners, our clinical work alone is full-time. 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. 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). Additionally, Cigna also continues to provide coverage for COVID-19 tests that are administered with a providers involvement or prescription after individualized assessment as outlined in this section and in Cignas COVID-19 In Vitro Diagnostic Testing coverage policy. If more than one telephone, Internet, or electronic health record contact(s) is required to complete the consultation request (e.g., discussion of test results), the entirety of the service and the cumulative discussion and information review time should be billed with a single code. It remains expected that the service billed is reasonable to be provided in a virtual setting. Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. BCBSNC Telehealth Corporate Reimbursement Policy CIGNA Humana Humana Telehealth Expansion 03/23/2020 Humana provider FAQs Medicaid Special Bulletin #28 03/30/2020 (Supersedes Special Bulletin #9) Medicare Telemedicine Provider Fact Sheet 03/17/2020 Medicare Waivers 03.30.2020 PalmettoGBA MLN Connects Special Edition - Tuesday, March 31, 2020 Coverage reviews for appropriate levels of care and medical necessity will still apply. 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. If the individual test is not part of a panel, but is part of a series of other pathogen tests that are performed, unbundling edits may apply. Listed below are place of service codes and descriptions. All Time (0 Recipes) Past 24 Hours Past Week Past month. Inflammation, sores or infection of the gums, and oral tissues, Guidance on whether to seek immediate emergency care, Board-certified dermatologists review pictures and symptoms; prescriptions available, if appropriate, Care for common skin, hair and nail conditions including acne, eczema, psoriasis, rosacea, suspicious spots, and more, Diagnosis and customized treatment plan, usually within 24 hours. No. Phone, video, FaceTime, Skype, Zoom, etc. As of January 1, 2021, we implemented a new Virtual Care Reimbursement Policy to ensure permanent coverage of virtual care services. 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. Cigna will allow direct emergent or urgent transfers from an acute inpatient facility to a second acute inpatient facility, skilled nursing facility (SNF), acute rehabilitation facility (AR), or long-term acute care hospital (LTACH). new codes. 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. For telehealth services rendered by a facility provider, report the CPT/HCPCS code with the applicable revenue code as would normally be done for an in-person visit, and also append either modifier 95 or GT. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. 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. New/Modifications to the Place of Service (POS) Codes for Telehealth This Change Request implements a new POS code (10) for Telehealth, as well as modifies the description for the existing POS code (02) for Telehealth. Yes. or Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. 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. In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. 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. Reimbursement for the administration of the injection will remain the same. Location, distinct from a hospital emergency room, an office, or a clinic, whose purpose is to diagnose and treat illness or injury for unscheduled, ambulatory patients seeking immediate medical attention. If the patient is in their home, use "10". When specific contracted rates are in place for diagnostic COVID-19 tests, Cigna will reimburse covered services at those contracted rates. NOTE: Please direct questions related to billing place of service codes to your Medicare Administrative Contractor (MAC) for assistance. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. To sign up for updates or to access your subscriber preferences, please enter your contact information below. 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. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. This is true for Medicare or other insurance carriers. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. Preventive care checkups and wellness screenings available at no additional cost, Routine care visits allow you to build a relationship with the same primary care provider (PCP) to helpmanage conditions, Prescriptions available through home delivery orat local pharmacies, if appropriate, Receive orders for biometrics, blood work andscreenings at local facilities, Skin conditions such as rashes, moles, eczema, and psoriasis, Care for hundreds of minor medical conditions, A convenient and affordable alternative to urgent, Schedule an appointment that works for you, You have the option to select the same provider for every session, Get prescriptions sent directly to your local pharmacy, if appropriate. Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. POS 02: Telehealth Provided Other than in Patient's Home ), 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 is a key difference between Commercial and Medicare risk . Modifier CS for COVID-19 related treatment. 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. Know how to bill a facility fee We also continue to make several additional accommodations related to virtual care until further notice. Billing Guidelines: Optum will reimburse telehealth services which use standard CPT codes for outpatient treatment and a GT, GQ or 95 modifier for either a video-enabled virtual visit or a telephonic session, to indicate the visit was conducted remotely. (This code is available for use effective January 1, 2013 but no later than May 1, 2013), A portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. Obtain your Member Code with just HK$100. The site is secure. 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. Activate your myCigna account nowto get access to a virtual dentist. This guidance applies to all providers, including laboratories. 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. Cigna does not provide additional reimbursement for PPE-related costs, including supplies, materials, and additional staff time (e.g., CPT codes 99072 and S8301), as office visit (E&M) codes include overhead expenses, such as necessary PPE. At this time, we are not waiving audit processes, but we will continue to monitor the situation closely. Yes. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. Yes, the cost-share waiver for COVID-19 treatment ended on February 15, 2021. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Place of Service 02 will reimburse at traditional telehealth rates. Intermediate Care Facility/ Individuals with Intellectual Disabilities. 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. This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. Last updated February 15, 2023 - Highlighted text indicates updates. A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. 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. Organizations that offer Administrative Services Only (ASO) plans will be opted in to waiving cost-share for this service as well. Cigna does require prior authorization for fixed wing air ambulance transport. In order to bill these codes, the test must be FDA approved or cleared or have received Emergency Use Authorization (EUA). We also continue to make several other accommodations related to virtual care until further notice. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). This includes: Please refer to the interim COVID-19 virtual care guidelines for a complete outline of our interim COVID-19 virtual care coverage. Primary care physician referrals for specialist office visits were temporarily waived for Individual & Family Plans (IFP) in Illinois and for all SureFit plans through May 31, 2021. "All Rights Reserved." This website and its contents may not be reproduced in whole or in part without . For COVID-19 related screening (i.e., quick phone or video consult): No cost-share for customers through at least, For non-COVID-19 related services (e.g., oncology visit, routine follow-up care): Standard customer cost-share. 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. Cigna has not lifted precertification requirements for scheduled surgeries. Cost-share will be waived for COVID-19 related services only when providers bill the appropriate ICD-10 code and modifier CS. We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information. Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. 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. When billing telehealth services, healthcare providers must bill the E&M code with place of service code 02 along with a GT or 95 modifier. Cigna will not make any limitation as to the place of service where an eConsult can be used. Important notes, What the accepting facility should know and do. My daily insurance billing time now is less than five minutes for a full day of appointments. Please review these changes by going to the Provider FastFax page and selecting fax number 30. 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. 200 Independence Avenue, S.W. We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. However, providers are required to attest that their designated specialty meets the requirements of Cigna. Certain PT, OT, and ST virtual care services remain reimbursable under the R31 Virtual Care Reimbursement Policy. The provider will need to code appropriately to indicate COVID-19 related services. Virtual care offered by Urgent Care Centers billing with code S9083 is reimbursable until further notice. Federal government websites often end in .gov or .mil. For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. Consistent with federal guidelines for private insurers, Cigna commercial will cover up to eight over-the-counter (OTC) diagnostic COVID-19 tests per month (per enrolled individual) with no out-of-pocket costs for claims submitted by a customer under their medical benefit. R33 COVID-19 Interim Billing Guidelines policy, COVID-19: In Vitro Diagnostic Testing coverage policy, COVID-19 In Vitro Diagnostic Testing coverage policy, Express Scripts discount prescription program, Centers for Medicare & Medicaid Services (CMS) COVID-19 vaccine resources, Cigna Coronavirus (COVID-19) Resource Center, 0001A, 0002A, 0003A, 0004A, 0011A, 0012A, 0013A, 0031A, 0034A, 0041A, 0042A, 0044A, 0051A, 0052A, 0053A, 0054A, 0064A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A, 0124A, 0134A, 0144A, 0154A, 0164A, 0173A, and M0201, Virtual screening telephone consult (5-10 minutes), Virtual or face-to-face visit for treatment of a, Drug and administration of infusion treatments for a confirmed COVID-19 case, M0220, M0221, M0222, M0223, M0240, M0241, M0243, M0244, M0245, M0246, M0247, M0248, M0249, Q0222, and M0250, COVID-19 laboratory testing (including PCR, antigen, and serology [i.e., antibody] tests), COVID-19 related diagnostic tests (other than COVID-19 test), Non COVID-19 virtual visit (i.e., telehealth), In-office or facility visit not related to COVID-19, Pfizer-BioNTech COVID-19 Vaccine Administration First Dose, Pfizer-BioNTech COVID-19 Vaccine Administration Second Dose, Pfizer-BioNTech COVID-19 Vaccine Administration Third Dose, Pfizer-BioNTech COVID-19 Vaccine Administration Booster, Moderna COVID-19 Vaccine Administration First Dose, Moderna COVID-19 Vaccine Administration Second Dose, Moderna COVID-19 Vaccine Administration Third Dose, Janssen COVID-19 Vaccine Administration Booster, Novavax COVID-19 Vaccine, Adjuvanted Administration First Dose, Novavax COVID-19 Vaccine, Adjuvanted Administration Second Dose, Novavax COVID-19 Vaccine, Adjuvanted Administration Booster, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - First dose, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Second dose, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Third dose, Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Booster, Moderna COVID-19 Vaccine (Low Dose) Administration Booster, Pfizer-BioNTech COVID-19 Pediatric Vaccine Administration First dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine Administration Second dose, Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration Third dose, Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration Booster, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration First dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration Second dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration Third dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration First dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration Second dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration Third dose, Moderna COVID-19 Vaccine (Blue Cap) 50MCG/0.5ML Administration Booster, Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration First dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration Second dose, Moderna COVID-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration Third dose, Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Gray Cap) Administration Booster Dose, Moderna COVID-19 Vaccine, Bivalent (Aged 18 years and older) (Dark Blue Cap with gray border) Administration Booster Dose, Moderna COVID-19 Vaccine, Bivalent (Aged 6 years through 11 years) (Dark Blue Cap with gray border) Administration Booster Dose, Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 5 years through 11 years) (Orange Cap) Administration Booster Dose, Moderna COVID-19 Vaccine, Bivalent (Aged 6 months through 5 years) (Dark Pink Cap and label with a yellow box) Administration Booster Dose, Pfizer-BioNTech COVID-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration Third dose, The initial COVID-19 diagnostic service (virtually, in an office, or at an emergency room, urgent care center, drive thru specimen collection center, or other facility), Specimen collection by a health care provider, Laboratory test (performed by state, hospital, or commercial laboratory; or other provider), Treatment (treatments that Cigna will cover for COVID-19 are those covered under Medicare or other applicable state regulations). 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. That is why in 2015, CMS began reimbursing providers for a program called non-complex Chronic Care Management (CCM), billed as the new code CPT 99490. Services provided on and after February 16, 2021 remain covered, but with standard customer cost-share.After the EUA or licensure of each COVID-19 treatment by the FDA, CMS will identify the specific drug code(s) along with the specific administration code(s) for each drug that should be billed. Cigna will determine coverage for each test based on the specific code(s) the provider bills. Share sensitive information only on official, secure websites. Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. Cigna will also administer the waiver for self-insured group health plans and the company encourages widespread participation, although these plans will have an opportunity to opt-out of the waiver option or opt-in to extend the waiver past February 15, 2021.