As of July 1, 2022, we request that providers bill with POS 02 for all virtual care. Prior authorization for treatment follows the same protocol as any other illness based on place of service and according to plan coverage. Cigna allowed providers to bill a standard face-to-face visit for all virtual care services, including those not related to COVID-19, through December 31, 2020 dates of service. 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). We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. Yes. Concurrent review will start the next business day with no retrospective denials. 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. A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. I cannot capture in words the value to me of TheraThink. Details, Watch this short video to learn more about virtual care with MDLive. 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. Yes. Yes. No. No. The Department may not cite, use, or rely on any guidance that is not posted Telehealth (also referred to as telemedicine) gives our members access to their health care provider from their home or another location. A facility or distinct part of a facility for psychiatric care which provides a total 24-hour therapeutically planned and professionally staffed group living and learning environment. 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. Cigna covers pre-admission and pre-surgical COVID-19 testing with no customer cost-share when performed in an outpatient setting through at least May 11, 2023. 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. Cigna commercial and Cigna Medicare Advantage are waiving the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. Approximately 98% of reviews are completed within two business days of submission. For covered virtual care services cost-share will apply as follows: No. Cigna commercial and Cigna Medicare Advantage customers receive the COVID-19 vaccine with no out-of-pocket costs; and. The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. 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. HIPAA does not require patient consent for consultation and coordination of care with health care providers in the ordinary course of treatment for their patients. 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). For telehealth, the 95 modifier code is used as well. 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. 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. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board. Codes 99441-99443 are non-face-to-face E/M services provided to a patient using the telephone by a physician or other QHP who may report E/M services. Cigna ultimately looks to the FDA, CDC, and ACIP to determine these factors. Cost share is waived for all covered eConsults through December 31, 2021. Schedule an appointment online with MDLIVE and visit a lab for your blood work and biometrics. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. 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. Denny and his team are responsive, incredibly easy to work with, and know their stuff. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. 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. 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. Other place of service not identified above. As a reminder, standard customer cost-share applies for non-COVID-19 related services. 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 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). For example, talking to a board-certified doctor for a minor medical issue costs less than an ER or urgent care center, and may even be less than an in-office Primary Care Provider (PCP) visit. Yes. Modifier 95, GT, or GQ must be appended to the virtual care code(s). The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna. We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. Activate your myCigna account nowto get access to a virtual dentist. We are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment. On January 1, 2021, we implemented a Virtual Care Reimbursement Policy that ensures permanent coverage of certain virtual care services. It's convenient, not costly. Providers administering the vaccine to individuals without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the Provider Relief Fund. website belongs to an official government organization in the United States. 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. for services delivered via telehealth. We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice. U.S. Department of Health & Human Services MLN Matters article MM7631, Revised and clarified place of service (POS) coding instructions. A medical facility operated by one or more of the Uniformed Services. 3 Biometric screening experience may vary by lab. Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. Cigna commercial and Cigna Medicare Advantage will waive the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. 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 Audio -only CPT codes 98966 98968 and 99441 This generally takes place in a mass immunization setting, such as, a public health center, pharmacy, or mall but may include a physician office setting. The White House announced the intent to end both the COVID-19 national emergency and public health emergency (PHE) on May 11, 2023. As of February 16, 2021 dates of service, cost-share applies. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). 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. If a patient presents for services other than COVID-19, Cigna will waive cost-share only for the COVID-19 related services (e.g., laboratory test). Please note that we continue to closely monitor and audit claims for inappropriate services that could not be performed virtually (e.g., acupuncture, all surgical codes, anesthesia, radiology services, laboratory testing, administration of drugs and biologics, infusions or vaccines, EEG or EKG testing, etc.). No. (Effective January 1, 2003). All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. 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. Claims must be submitted on a CMS-1500 form or electronic equivalent. PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. Telehealth claims with any other POS will not be considered eligible for reimbursement. Cigna will only reimburse claims for covered OTC COVID-19 tests submitted by customers under their medical benefit and by certain pharmacy retailers under the pharmacy benefit, as elected by clients. Once completed, telehealth will be added to your Cigna specialty. A facility which primarily provides to residents skilled nursing care and related services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care services above the level of custodial care to other than individuals with intellectual disabilities. In addition, Anthem would recognize telephonic-only . 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. As of July 1, 2022, standard credentialing timelines again apply. The following Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes are used to bill for telebehavioral and telemental health services and have been codified into the current Medicare Physician Fee Schedule (PFS).