To speak with a dentist,log in to myCigna. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. 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. Yes. In addition, these requirements must be met: This guidance applies for all providers, including urgent care centers and emergency rooms, and applies to customers enrolled in Cigna's employer-sponsored plans in the United States and the Individual & Family plans available through the Affordable Care Act. All synchronous technology used must be secure and meet or exceed federal and state privacy requirements. One of our key goals is to help customers connect to affordable, predictable, and convenient care anytime, anywhere. Please note that all technology used must be secure and meet or exceed federal and state privacy requirements. Cigna continues to require prior authorization reviews for routine advanced imaging. For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. 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 no specific contracted rates are in place, providers will be reimbursed $40 per dose for general vaccine administration and an additional $35.50 per dose for administering it in a home setting for total reimbursement of $75.50 per vaccine dose. Services include methadone and other forms of Medication Assisted Treatment (MAT). For the purposes of private practice, the three most common service codes therapists are likely to bill are "11" (office), "12" (in-home services), and "2" (telehealth). As always, we remain committed to ensuring that: Yes. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. ), 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 waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. 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 facility (place of service 32), or to an individuals home (place of service 12) to collect the specimen. We also continue to work directly with providers to understand the financial implications that virtual care reimbursement may have on practices. Usually not. What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? 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). We also referenced the current list of covered virtual care codes by the CMS to help inform our coverage strategy. 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. Cigna will not make any requirements as it relates to virtual services being for a new or existing patient. Must be performed by a licensed provider. Modifier 95, GT, or GQ must be appended to the virtual care code(s). Please note that we continue to request that providers do not bill with modifiers 93 or FQ at this time. No. A facility/unit that moves from place-to-place equipped to provide preventive, screening, diagnostic, and/or treatment services. Cigna currently allows for the standard timely filing period plus an additional 365 days. Intake / Evaluation (90791) Billing Guide, Evaluation with Medical Assessment (90792). What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? were all appropriate to use). Cost-share will be waived only when providers bill the appropriate ICD-10 code (U07.1, J12.82, M35.81, or M35.89). As a result, Cigna's cost-share waiver for diagnostic COVID-19 tests and related office visits is extended through May 11, 2023. 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. means youve safely connected to the .gov website. 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. This includes providers who typically deliver services in a facility setting. A facility, other than a hospital's maternity facilities or a physician's office, which provides a setting for labor, delivery, and immediate post-partum care as well as immediate care of new born infants. Certain PT, OT, and ST virtual care services remain reimbursable under the R31 Virtual Care Reimbursement Policy. For the R31 Virtual Care Reimbursement Policy, effective January 1, 2021, we continue to not make any requirements regarding the type of synchronous technology used until further notice. This means that providers could perform services for commercial Cigna medical customers in a virtual setting and bill as though the services were performed face-to-face. 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 An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. Certain client exceptions may apply to this guidance. Reimbursement for codes that are typically billed include: Yes. The site is secure. A facility that provides comprehensive rehabilitation services under the supervision of a physician to inpatients with physical disabilities. 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. No authorization is required for the procurement or administration of COVID-19 infusion treatments. 3. No. Yes. Additional information about the COVID-19 vaccines, including planning for a vaccine, vaccine development, getting vaccinated, and vaccine safety can be found on the CDC website. Providers should bill this code for dates of service on or after December 23, 2021. Whether physicians report the audio-only encounter to a private payer as an office visit (99201-99215) or telephone E/M service (99441-99443) will depend on what the physician is able to document . Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing. When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). Once completed, telehealth will be added to your Cigna specialty. This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. For more information about current Evernorth Behavioral Health virtual care guidance, please visit CignaforHCP.com > Resources > Behavioral Resources > Doing Business with Cigna >, For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com >, Outpatient E&M codes for new and established patients (99202-99215), Physical and occupational therapy E&M codes (97161-97168), Annual wellness visit codes (G0438 and G0439), Services must be on the list of eligible codes contained within in our. Primary care physician to specialist requesting input from a cardiologist, psychiatrist, pulmonologist, allergist, dermatologist, surgeon, oncologist, etc. As of February 16, 2021 dates of service, cost-share applies. Clarifying Codes G0463 and Q3014 Unfortunately, this policy also created a great deal of confusion and inconsistency among providers regarding which code to bill when providing remote clinic visits: G0463, Hospital outpatient clinic visit for assessment and management of a patient, or Q3014, Telehealth originating site facility fee. While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. 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. The Department may not cite, use, or rely on any guidance that is not posted Standard cost-share will apply for the customer, unless waived by state-specific requirements. 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. 3. Know how to bill a facility fee Billing an evaluation and management (E/M) code when that level of service is not provided is fraudulent billing and is expressly prohibited. No. 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. 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. Cigna remains fully staffed, and is committed to ensuring that precertification requests are reviewed in a timely manner and that there is no interruption of claims processing or claims payments. 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). Prior authorization is not required for COVID-19 testing. 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. Activate your myCigna account nowto get access to a virtual dentist. Emergent transport to nearby facilities capable of treating customers is covered without prior authorization. Yes. Talk to a licensed dentist via a video call, 24/7/365. Please note that this guidance applies to drive through testing as well, and includes services performed by a free-standing emergency room or any other provider. Please review our COVID-19 In Vitro Diagnostic Testing coverage policy for a list of additional services and ICD-10 codes that are generally not covered. To receive payment equivalent to a normal face-to-face visit you will not bill POS 2 and instead will follow Medicare guidance to bill POS 11 as if care was delivered in the office during COVID-19. To help remove any barriers to receive testing, Cigna will cover any diagnostic molecular or antigen diagnostic test for COVID-19, including rapid tests and saliva-based tests, through at least May 11, 2023. 31, 2022. 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. 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 Thank you. A facility or location owned and operated by a federally recognized American Indian or Alaska Native tribe or tribal organization under a 638 agreement, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to tribal members admitted as inpatients or outpatients.

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