On January 1, 2021, we implemented a Virtual Care Reimbursement Policy that ensures permanent coverage of certain virtual care services. 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. 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. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. 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. Through December 31, 2020 dates of service, providers could deliver virtual neuropsychological and psychological testing services and bill their regular face-to-face CPT codes that were on their fee schedule . Important notes, What the accepting facility should know and do. 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. All other customers will have the same cost-share as if they received the services in-person from that same provider. 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. Telehealth claims with any other POS will not be considered eligible for reimbursement. These codes do not need a place of service (POS) 02 or modifier 95 or GT. This policy will be reviewed periodically for changes based on the evolving COVID-19 PHE and updated CMS or state specific rules 1 based on executive orders. Intermediate Care Facility/ Individuals with Intellectual Disabilities. 24/7, live and on-demand for a variety of minor health care questions and concerns. A land vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. Free Account Setup - we input your data at signup. 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. Please note that some opt-outs for self-funded benefit plans may have applied. Cigna will factor in the current strain on health care systems and will incorporate this information into retrospective reviews. This form can be completed here:https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf. The codes may only be billed once in a seven day time period. When all requirements are met, covered services are currently reimbursed at 100% of face-to-face rates (i.e., parity). For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. 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. 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. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). 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 Cost-share is waived when G2012 is billed for COVID-19 related services consistent with our, ICD-10 code Z03.818, Z11.52, Z20.822, or Z20.828, POS 02 and GQ, GT, or 95 modifier for virtual care. Claims were not denied due to lack of referrals for these services during that time. To sign up for updates or to access your subscriber preferences, please enter your contact information below. Place of Service 02 in Field 24-B (see sample claim form below) For illustrative purposes only. No. No. You want to know you can call your billing admin, a real person you've already spoken with, and get immediate answers about your claims. Providers should bill this code for dates of service on or after December 23, 2021. MLN Matters article MM12427, New modifications to place of service (POS) codes for telehealth. There may be limited exclusions based on the diagnoses submitted. POS 10 Telehealth provided in a patient's home was created for services provided remotely to a patient in their private residence. Yes. Yes. Inpatient COVID-19 care that began on or before February 15, 2021, and continued after February 16, 2021, will have cost-share waived for the entire course of the facility stay. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing. All Cigna pharmacy and medical plans will cover Paxlovid and molnupiravir at any pharmacy or doctors office (in- or out-of-network) that has them available. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. 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. 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. These codes should be used on professional claims to specify the entity where service (s) were rendered. 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. In 2017, Cigna launched behavioral telehealth sessions for all their members. A medical facility operated by one or more of the Uniformed Services. Specialist to specialist (e.g., ophthalmologist requesting consultation from a retina specialist, orthopedic surgeon requesting consultation from an orthopedic surgeon oncologist, cardiologist with an electrophysiology cardiologist, and obstetrician from a maternal fetal medicine specialist), Hospitalist requests an infectious disease consultation for pulmonary infections to guide antibiotic therapy, The ICD-10 code that represents the primary condition, symptom, or diagnosis as the purpose of the consult; and. Yes. Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. Yes. (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. 1 In an emergency, always dial 911 or visit the nearest hospital. No. 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). However, facilities will not be penalized financially for failure to notify us of admissions. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Modifier CR or condition code DR can also be billed instead of CS. 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. lock TheraThink.com 2023. Official websites use .govA All synchronous technology used must be secure and meet or exceed federal and state privacy requirements. new codes. All Cigna Customers will pay $0 ingredient cost while funded by government, while Cigna commercial customers will pay up to a $6 dispensing fee when obtained at a pharmacy where the medications are available. Hospitals are still required to make their best efforts to notify Cigna of hospital admissions in part to assist with discharge planning. 3 Biometric screening experience may vary by lab. We will continue to monitor inpatient stays. No additional modifiers are necessary to include on the claim. Yes. INTERIM TELEHEALTH GUIDANCE Announcement from Cigna Behavioral Health . Medicare telehealth services practitioners use "02" if the telehealth service is delivered anywhere except for the patient's home. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. As private practitioners, our clinical work alone is full-time. ( When no specific contracted rates are in place, Cigna will reimburse the administration of all EUA vaccines at the established national CMS rates when claims are submitted under the medical benefit to ensure timely, consistent, and reasonable reimbursement. Providers will not need a specific consent from patients to conduct eConsults. Telephone, Internet, or electronic health record consultations of less than five minutes should not be billed. We are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. Sign up to get the latest information about your choice of CMS topics. 31, 2022. Washington, D.C. 20201 Summary of Codes for Use During State of Emergency. Outpatient E&M codes for new and established patients (99202-99215) Physical and occupational therapy E&M codes (97161-97168) Telephone-only E&M codes (99441-99443) Annual wellness visit codes (G0438 and G0439) For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. 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. For dates of service April 14, 2020 through at least May 11, 2023, Cigna will cover U0003 and U0004 with no customer cost-share when billed by laboratories using high-throughput technologies as described by CMS. First Page. One of our key goals is to help your patients connect to affordable, predictable, and convenient care anytime, anywhere. 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. 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. 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. eConsult services remain covered; however, customer cost-share applies as of January 1, 2022. For covered virtual care services cost-share will apply as follows: No. Please visit CignaforHCP.com/virtualcare for additional information about that policy. 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. Cost-share was waived through February 15, 2021 dates of service. No. And as your patients seek more convenient and safe care options, we continue to see growing interest in virtual care (i.e., telehealth) especially from consumers and their providers who want to ensure they have greater access and connection to each other. Area (s) of Interest: Payor Issues and Reimbursement. Get non-narcotic prescriptions sent directly to your local pharmacy, if appropriate. The cost-share waiver for COVID-19 diagnostic testing and related office visits is in place at least until the end of Public Health Emergency (PHE) period. 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. Precertification (i.e., prior authorization) requirements remain in place. After the emergency use authorization (EUA) or licensure of each COVID-19 vaccine product by the FDA, CMS will identify the specific vaccine code(s) along with the specific administration code(s) for each vaccine that should be billed. In these cases, the non-credentialed provider can bill under the group assuming they are practicing within state laws to administer the vaccine. 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. Yes. This will help with tracking purposes, and ensure timely reimbursement for the administration of the treatment. It must be initiated by the patient and not a prior scheduled visit. Effective January 1, 2021, we implemented a new. The ICD-10 codes for the reason of the encounter should be billed in the primary position. Telehealth services not billed with 02 will be denied by the payer. Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; (As of 01/21/2021) What Common Procedural Technology (CPT) codes should be used for COVID-19 testing? Yes. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. lock Mid-level practitioners (e.g., physician assistants and nurse practitioners) can also provide services virtually using the same guidance. Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. While services billed on a UB-04 are out of scope for the new policy, we will continue to evaluate facility-based services for future policy updates. No. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. While we encourage PT/OT/ST providers to follow CMS guidance regarding the use of software programs for virtual care, we are not requiring the use of any specific software program at this time. Concurrent review will start the next business day with no retrospective denials. While Cigna does not require any specific placement for COVID-19 diagnosis codes on a claim, we recommend providers include the COVID-19 diagnosis code for confirmed or suspected COVID-19 patients in the first position when the primary reason the patient is treated is to determine the presence of COVID-19. 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. 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. For details, see the CMS document titled Place of Service Codes for Professional Claims Database (updated September 2021). He co-founded a mental health insurance billing service for therapists called TheraThink in 2014 to specifically solve their insurance billing problems. However, CMS published additional details about their new initiative to cover FDA approved, authorized, or cleared over-the-counter (OTC) COVID-19 tests at no cost. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other . Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. Our national ancillary partner American Specialty Health (ASH) is applying the same virtual care guidance, so any provider participating through ASH and providing PT/OT services to Cigna customers is covered by the same guidance. Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. Yes. When no specific contracted rates are in place, Cigna will reimburse the administration of all emergency use authorized (EUA) vaccines at the established national, Cigna will reimburse vaccinations administered in a home setting an additional $35.50 per dose consistent with the established national. When a customer receives virtual care services from their regular doctor (or any other provider) as part of this policy and when the provider bills with POS 02 customers with certain benefit plans may have a lower cost-share. Unless your office was approved to be a facility to administer virtual patient care, then it is best to bill using the telehealth code (11) Office. Please note that certain client exceptions may apply (e.g., clients may opt out of the treatment cost-share waiver or opt-in for an extension of the cost-share waiver). The provider will need to code appropriately to indicate COVID-19 related services. However, this added functionality is planned for a future update. Modifier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): . In order to bill these codes, the test must be FDA approved or cleared or have received Emergency Use Authorization (EUA). EAP sessions are allowed for telehealth services. No. 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. Providers should bill one of the above codes, along with: No. Product availability may vary by location and plan type and is subject to change. These resources offer access to live-guided relaxation sessions, wellness podcasts, and wellness and stress management flyers. Cigna will not reimburse providers for the cost of the vaccine itself. Instead, U07.1, J12.82, M35.81, or M35.89 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnosis. Providers can call Cigna customer service at 1.800.88Cigna (882.4462) to check a patients eligibility information, including if their plan offers coverage for these purposes. The .gov means its official. Through March 31, 2021, if the customer already had an approved authorization request for the service, another precertification request was not needed if the patient is being referred to another similar participating provider that offers the same level of care (e.g., getting a CT scan at another facility within the same or separate facility group). In these cases, the urgent care center should append a GQ, GT, or 95 modifier, and we will reimburse the full face-to-face rate for insured and Non-ERISA ASO customers in states where telehealth parity laws exist. It depends upon the clients benefit plan, but as noted above, testing is usually not covered for these purposed because most standard Cigna client benefit plans do not cover non-diagnostic tests for these non-diagnostic reasons. State and federal mandates, as well as customer benefit plan designs, may supersede our guidelines. Intake / Evaluation (90791) Billing Guide, Evaluation with Medical Assessment (90792). The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates.

Select The Correct Statements About Transmission And Exposure, Decades Channel On Spectrum 2020, Msc Seashore Room Service Menu, Articles C