Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF). Further, we will continue to monitor virtual care health outcomes and claims data as well as provider, customer, and client feedback to ensure that our reimbursement and coverage strategy continues to meet the needs of those we serve. A facility which primarily provides health-related care and services above the level of custodial care to individuals but does not provide the level of care or treatment available in a hospital or SNF. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. 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. 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 continues to reimburse participating providers when they are credentialed to practice medicine per state regulations, have a current contract, and have completed the Cigna credentialing process.Non-participating providers will only be reimbursed if: Yes. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other . 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 Cigna continues to require prior authorization reviews for routine advanced imaging. Below is a definition of POS 02 and POS 10 for CMS-1500 forms, alongside a list of major insurance brands and their changes. If a provider 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. New and revised codes are added to the CPBs as they are updated. 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). *Please Note: virtual check-in and E-visit codes must be billed with Place of Service (POS) 02 and modifier GT. A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders. When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). Please review our R33 COVID-19 Interim Billing Guidelines policy for ICD-10 diagnosis code requirements to have cost-share waived for G2012. lock Store and forward communications (e.g., email or fax communications) are not reimbursable. For details, see the CMS document titled Place of Service Codes for Professional Claims Database (updated September 2021). 2 Limited to labs contracted with MDLIVE for virtual wellness screenings. 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 You free me to focus on the work I love!. Live-guided relaxation by telephone Available for all providers at no cost Every Tuesday at 5:00pm ET Call 866.205.5379, enter passcode 113 29 178, and then press # Additional Resources Cigna Medicare Billing guidelines and telehealth Cigna Dental Interim Communication to Providers QualCare Workers Compensation Interim billing guidance Certain PT, OT, and ST virtual care services remain reimbursable under the R31 Virtual Care Reimbursement Policy. Cigna will determine coverage for each test based on the specific code(s) the provider bills. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. for services delivered via telehealth. representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). ), Preventive care services (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) [Effective with January 29, 2022 dates of service]. Medicare requires audio-video for office visit (CPT 99201-99215) telehealth services. Place of Service 02 will reimburse at traditional telehealth rates. Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. 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. Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. Over the past several years and accelerated during COVID-19 we have collaborated with and sought feedback from many local and national medical societies, provider groups in our network, and key collaborative partners that have suggested certain codes and services that should be addressed in a virtual care reimbursement policy. Providers will continue to be reimbursed at 100% of their face-to-face rates for covered virtual care services, even when billing POS 02. No. Yes. Yes. Hospitals are still required to make their best efforts to notify Cigna of hospital admissions in part to assist with discharge planning. 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. 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. Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004. COVID-19 admissions would be emergent admissions and do not require prior authorizations. Providers can, however, bill the vaccine code (e.g., 91300 for the Pfizer vaccine or 91301 for the Moderna vaccine) with a nominal charge (e.g., $.01), but it is not required to be billed in order to receive reimbursement for the administration of the vaccine. However, providers are required to attest that their designated specialty meets the requirements of Cigna. Schedule an appointment online with MDLIVE and visit a lab for your blood work and biometrics. When multiple services are billed along with S9083, only S9083 will be reimbursed. ), 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. 2. Yes. Cigna commercial and Cigna Medicare Advantage are waiving the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. 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. In order to bill these codes, the test must be FDA approved or cleared or have received Emergency Use Authorization (EUA). If antibodies are present, it means that individual previously had a specific viral or bacterial infection - like COVID-19. Cigna recommends video services but allows telephonic sessions; however they may require review for medical necessity. These codes should be used on professional claims to specify the entity where service (s) were rendered. The location where health services and health related services are provided or received, through telecommunication technology. Before sharing sensitive information, make sure youre on a federal government site. Bill those services on a CMS-1500 form or electronic equivalent. Yes. These codes should be used on professional claims to specify the entity where service(s) were rendered. The COVID-19 billing and reimbursement guidelines that follow are for commercial Cigna medical services, including IFP, unless otherwise noted. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). It remains expected that the service billed is reasonable to be provided in a virtual setting. Generally, only well-equipped commercial laboratories and hospital-based laboratories will have the necessary equipment to offer these tests. No. Modifier 95, GT, or GQ must be appended to the virtual care code(s). Providers should bill this code for dates of service on or after December 23, 2021. Ultimately however, care must be medically necessary to be covered. When specific contracted rates are in place for COVID-19 vaccine administration services, Cigna will reimburse covered services at those contracted rates. For services where COVID-19 is not the initial clinical presentation (e.g., appendectomy, labor and delivery, etc. Cost-share is waived only when providers bill one of the identified codes. 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. Yes. Cost share is waived for all covered eConsults through December 31, 2021. In such cases, we will review the services provided on appeal for medical necessity to determine appropriate coverage.As a reminder, precertification is not required for the evaluation, testing, or medically necessary treatment of Cigna customers related to COVID-19. Please visit CignaforHCP.com/virtualcare for additional information about that policy. Cigna will allow reimbursement for these codes by any provider or facility only when billed without any other codes (except where the contract allows it). 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 Yes. No additional credentialing or notification to Cigna is required. Yes. Emergent transport to nearby facilities capable of treating customers is covered without prior authorization. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. new codes. The interim COVID-19 virtual care guidelines were solely in place through December 31, 2020, and this new policy took effect on January 1, 2022. (99441, 98966, 99442, 98967, 99334, 98968). In certain cases, yes. There may be limited exclusions based on the diagnoses submitted. Patient is not located in their home when receiving health services or health related services through telecommunication technology. Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. Approximately 98% of reviews are completed within two business days of submission. As of July 1, 2022, we request that providers bill with POS 02 for all virtual care. identify telehealth or telephone (audio only) services that were historically performed in the office or other in person setting (E.g. 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. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. Non-contracted providers should use the Place of Service code they would have used had the . An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. 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. A provider should bill on the same form they usually do (e.g., CMS 1500 or UB-04) as when they provide the service face-to-face. Cigna will not make any requirements as it relates to virtual services being for a new or existing patient. As private practitioners, our clinical work alone is full-time. Modifier 95, GT, or GQ must be appended to the appropriate CPT or HCPCS procedure code(s) to indicate the service was for virtual care. Yes. This code will only be covered where state mandates require it. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. 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. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. 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.