POS 02: Telehealth Provided Other than in Patient's Home Our newest Playbook in the series focuses on the implementation of telehealth (PDF), defined as real-time, audio-visual visits between a clinician and patient. 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. A portion of a hospitals main campus which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. 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. Cigna will reimburse Remdesivir for COVID-19 treatment when administered in inpatient or outpatient settings at the national CMS reimbursement rate (or average wholesale pricing [AWP] if a CMS rate is not available) when the drug costs are not included in case rates or per diems to ensure timely, consistent, and reasonable reimbursement. 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. Federal government websites often end in .gov or .mil. New/Modifications to the Place of Service (POS) Codes for Telehealth. This includes providers who typically deliver services in a facility setting. Anthem would recognize IOP services that are rendered via telehealth with a revenue code (905, 906, 912, 913), plus CPT codes for specific behavioral health services. Certain client exceptions may apply to this guidance. Reimbursement will be consistent as though they performed the service in a face-to-face setting. 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. The site is secure. For all other IFP plans outside of Illinois, primary care physicians are still encouraged to coordinate care and assist in locating in-network specialists, but the plans no longer have referral requirements as of January 1, 2021. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. Cigna will only cover non-diagnostic PCR, antigen, and serology (i.e., antibody) tests when covered by the client benefit plan. Subscribe now with just HK$100. Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. Cost-share will be waived only when providers bill the appropriate ICD-10 code (U07.1, J12.82, M35.81, or M35.89). Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. POS 11, 19 and 22) modifier GT or 95 (or GQ for Medicaid) must be used. No. DISCLAIMER: The contents of this database lack the force and effect of law, except as Refer to the Telemedicine Website for a list of billing codes which may be used with Place of Service (POS) 02 or 10. lock 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. Yes. A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services rendered by, or under the supervision of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Cost-share is waived only when billed by a provider or facility without any other codes. 24/7, live and on-demand for a variety of minor health care questions and concerns. Is there a code that we can use to bill for this other than 99441-99443? 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. Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. Yes. We are awaiting further billing instructions for providers, as applicable, from CMS. The U.S. Food and Drug Administration (FDA) recently approved for emergency use two prescription medications for the treatment of COVID-19: PaxlovidTM (from Pfizer) and molnupiravir (from Merck). If the home health service(s) are done for COVID-19 related treatment, cost-share will be waived for covered services through February 15, 2021 when providers bill ICD-10 code U07.1, J12.82, M35.81, or M35.89. We added a number of additional codes in March and April 2022 that are now eiligible for reimbursement. You can call, text, or email us about any claim, anytime, and hear back that day. The codes may only be billed once in a seven day time period. Once completed, telehealth will be added to your Cigna specialty. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. (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. Deliver services that are covered by the Virtual Care Reimbursement Policy; Bill consistently with the requirements of the policy; and. Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 In 2017, Cigna launched behavioral telehealth sessions for all their members. Cigna will reimburse providers the full allowed amount of the claim, including what would have been the customer's cost share. 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. All other customers will have the same cost-share as if they received the services in-person from that same provider. Denny and his team are responsive, incredibly easy to work with, and know their stuff. For more information about current Evernorth Behavioral Health virtual care guidance, please visit CignaforHCP.com > Resources > Behavioral Resources > Doing Business with Cigna > COVID-19: Interim Guidance. As of February 16, 2021 dates of service, these treatments remain covered, but with standard customer cost-share. Cigna commercial and Cigna Medicare Advantage will not directly reimburse claims submitted under the medical benefit by retailers or by health care providers like hospitals, urgent care centers, and primary care groups for OTC COVID-19 tests, including when billed with CPT code K1034. ICD-10 diagnosis codes that generally reflect non-covered services are as follows. 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 (when billed on the same or different claims). If a provider typically delivered face-to-face services in a facility setting, that provider could also deliver any appropriate service virtually consistent with existing Cigna policies through December 31, 2020 dates of service. Product availability may vary by location and plan type and is subject to change. This code will only be covered where state mandates require it. Note: We only work with licensed mental health providers. For more information, including details on how you can get reimbursed for these tests from original Medicare when you directly supply them to your patients with Part B or Medicare Advantage plans, please, U0003: $75 per test (high-throughput PCR-based coronavirus test)*, U0004: $75 per test (any technique with high-throughput technology)*, U0005: $25 (when test results are returned within two days)*, Routine and/or executive physicals (Z02.89). Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. Cigna currently allows for the standard timely filing period plus an additional 365 days. April 14, 2021. No. (Description change effective January 1, 2016). A short term accommodation such as a hotel, camp ground, hostel, cruise ship or resort where the patient receives care, and which is not identified by any other POS code. While Cigna doesn't require further credentialing or license validation, and the provider can work under the scope of their license, providers are encouraged to inform Cigna when they will practice across state lines. We have also created this quick guide for key implementation tips and the latest updates on telemedicine expansion amid COVID-19. Telehealth can provide many benefits for your practice and your patients, including increased Please note that HMO and other network referrals remained required through the pandemic, so providers should have continued to follow the normal process that has been in place. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. As always, we remain committed to providing further updates as soon as they become available. Diagnostic tests, which indicate if the individual carries the virus and can infect others, Serology (i.e., antibody) tests, which indicate if the individual had a previous infection and has now potentially developed an immune response, An individual seeks and receives a COVID-19 diagnostic test from a licensed or authorized health care provider; or, A licensed or authorized health care provider refers an individual for a COVID-19 diagnostic test; and, The laboratory test is FDA approved or cleared or has received Emergency Use Authorization (EUA); and, The test is run in a laboratory, office, urgent care center, emergency room, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU; and, The results of a molecular or antigen test are non-diagnostic for COVID-19 and the results of the antibody test will be used to aid in the diagnosis of a condition related to COVID-19 antibodies (e.g., Multisystem Inflammatory Syndrome); and. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with the CMS reimbursement rates noted below to ensure timely, consistent and reasonable reimbursement. 1995-2020 by the American Academy of Orthopaedic Surgeons. Excluded physician services may be billed 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. website belongs to an official government organization in the United States. Following the recent statement from the National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel indicating that a three-dose regimen of Remdesivir in the outpatient setting can be effective in preventing progression to severe COVID-19, CMS created HCPCS code J0248 when administering Remdesivir in an outpatient setting. 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). Cigna will not reimburse providers for the cost of the vaccine itself. When all requirements are met, covered services are currently reimbursed at 100% of face-to-face rates (i.e., parity). For additional information about our Virtual Care Reimbursement Policy, providers can contact their provider representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). 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. Sign up to get the latest information about your choice of CMS topics. 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. Diluents are not separately reimbursable in addition to the administration code for the infusion. When multiple services are billed along with S9083, only S9083 will be reimbursed. 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. Please note that if the only service rendered is a specimen collection and/or testing, and all of the required components for an evaluation and management (E/M) service code are not met, then only the code for the specimen collection or testing should be billed. Please know that we 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. ), 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. Congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. Issued by: Centers for Medicare & Medicaid Services (CMS). Please note that cost-share still applies for all non-COVID-19 related services. Yes. As of April 1, 2021, Cigna resumed standard authorization requirements. or Claims were not denied due to lack of referrals for these services during that time. For the immediate future, we will continue to reimburse virtual care services consistent with face-to-face rates. Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004. Psychiatric Facility-Partial Hospitalization. There are two primary types of tests for COVID-19: A serology (i.e., antibody) test for COVID-19 is considered diagnostic and covered without cost-share through at least May 11, 2023 when ALL of the following criteria are met: When specific contracted rates are in place for diagnostic COVID-19 serology tests, Cigna will reimburse covered services at those contracted rates. Cigna will allow commercial and behavioral providers who are participating with Cigna (and who have up-to-date credentialing) to provide in-person or virtual care in other states to the extent that the scope of the license and state regulations allow such care to take place. (As of 10/14/2020) Where can providers access the telemedicine policy and related codes? In addition, Cigna recognizes and expects that providers will continue to follow their usual business practices regarding onboarding new providers, locum tenens, and other providers brought in to cover practices or increase care during times of high demand. One of our key goals is to help customers connect to affordable, predictable, and convenient care anytime, anywhere. (Effective January 1, 2016). 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. Cigna does not generally cover tests for asymptomatic individuals when the tests are performed for general public health surveillance, for employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19. For services provided through February 15, 2021, providers will need to bill consistent with our interim billing guidelines by including the Diagnosis code (Dx) U07.1, J12.82, M35.81, or M35.89 on claims related to the treatment of COVID-19. For virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02. Primary care physician to specialist requesting input from a cardiologist, psychiatrist, pulmonologist, allergist, dermatologist, surgeon, oncologist, etc. Your access portal for updated claims and reports is secured via our HTTPS/SSL/TLS secured server. Yes. Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. Antibody tests: 86328, 86769, 86408, 86409, 86413, and 0224U, Cigna covers diagnostic molecular and antigen tests for COVID-19 through at least. Unless telehealth requirements are . Yes. Cigna will waive all customer cost-share for diagnostic services, testing, and treatment related to COVID-19, as follows: The visit will be covered without customer cost-share if the provider determines that the visit was consistent with COVID-19 diagnostic purposes. PT/OT/ST providers should continue to submit virtual claims with a GQ, GT, or 95 modifier and POS 02, and they will be reimbursed at their face-to-face rates. For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed. Cigna will not make any requirements as it relates to virtual services being for a new or existing patient. Neither U0003 nor U0004 should be used for tests that are used to detect COVID-19 antibodies. Providers should append the GQ, GT, or 95 modifier and Cigna will reimburse them consistent with their face-to-face rates. 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. Mid-level practitioners (e.g., physician assistants and nurse practitioners) can also provide services virtually using the same guidance. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. Cigna will determine coverage for each test based on the specific code(s) the provider bills. Approximately 98% of reviews are completed within two business days of submission. A facility other than a hospital, which provides dialysis treatment, maintenance, and/or training to patients or caregivers on an ambulatory or home-care basis. We are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. Comprehensive Outpatient Rehabilitation Facility. Yes. A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. Providers will continue to be reimbursed at 100% of their face-to-face rates for covered virtual care services, even when billing POS 02. As of February 16, 2021 dates of service, cost-share applies. At a minimum, we will always follow Centers for Medicare & Medicaid Services (CMS) telehealth or state-specific requirements that apply to telehealth coverage for our insurance products. 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 . Cigna commercial and Cigna Medicare Advantage customers receive the COVID-19 vaccine with no out-of-pocket costs; and. 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. As private practitioners, our clinical work alone is full-time. Denny has interviewed hundreds of mental health practitioners to better understand their struggles and solutions, all with the goal of making the professional side of behavioral health a little easier, faster, and less expensive. Audio-only encounters can be provided using the telephone evaluation and management codes (CPT codes. As always, we remain committed to ensuring that: Yes. 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. The Department may not cite, use, or rely on any guidance that is not posted As of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. For additional information about our coverage of the COVID-19 vaccine, please review our. For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. No. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. Note that high-throughput tests may only be run in a high-complexity laboratory; The laboratory or provider bills using the codes in our interim billing guidelines and. Yes. 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. When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. over a 7-day period. Patient is not located in their home when receiving health services or health related services through telecommunication technology. Hi Laelia, I'd be happy to help. For dates of service April 1 - June 30, 2022, Cigna will apply a 1% payment adjustment. As a reminder, standard customer cost-share applies for non-COVID-19 related services. 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