(Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.). Providers who offer telehealth options can use digital audio-visual technologies that are HIPAA-compliant. If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice. For dates of service April 1 - June 30, 2022, Cigna will apply a 1% payment adjustment. Therefore, effective with August 15 dates of service, Cigna will reimburse providers consistent with CMS rates for doses of bebtelovimab that they purchase directly from the manufacturer. (Effective January 1, 2003), 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 who do not require hospitalization. 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. When administered consistently with Cigna's Drug and Biologics policy and EUA usage guidelines, Cigna will reimburse the infusion and post-administration monitoring of the listed treatments at contracted rates when specific contracted rates are in place for COVID-19 services. Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. (Effective January 1, 2016). When performing tests for these purposes, providers should bill the appropriate laboratory code (e.g., U0002) following our existing billing guidelines and testing coverage policy, and use the diagnosis code Z02.79 to indicate the test was performed for return-to-work or diagnosis code Z02.0 to indicate the test was performed for return-to-school purposes. Talk directly to board-certified providers 24/7 by video or phone for help with minor, non-life-threatening medical conditions1. End-Stage Renal Disease Treatment Facility. Diluents are not separately reimbursable in addition to the administration code for the infusion. We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice. Cost-share is waived only when billed by a provider or facility without any other codes. 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 wanted to implement a policy that ensures you can continue to receive ongoing reimbursement for virtual care that you deliver to your patients with Cigna commercial medical coverage. As private practitioners, our clinical work alone is full-time. all continue to be appropriate to use at this time. representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). Yes. Modifier CR or condition code DR can also be billed instead of CS. Yes. 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 covered the administration and post-administration monitoring of EUA-approved COVID-19 infusion treatments with no customer-cost share for services provided through February 15, 2021. Place of Service Code Set. Phone, video, FaceTime, Skype, Zoom, etc. As the government is providing the initial vaccine doses free of charge to health care providers, Cigna will not reimburse providers for the cost of the vaccine itself. U.S. Department of Health & Human Services Yes. No. The 02 Place of Service code will automatically populate onto your courtesy claims and Superbills when the appointment is scheduled at that location. Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. Diluents are not separately reimbursable in addition to the administration code for the infusion. website belongs to an official government organization in the United States. Heres how you know. You'll always be able to get in touch. 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. identify telehealth or telephone (audio only) services that were historically performed in the office or other in person setting (E.g. Yes. Must be performed by a licensed provider. Yes. TheraThink.com 2023. 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. For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. No additional credentialing or notification to Cigna is required. 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. POS 10 Telehealth provided in a patient's home was created for services provided remotely to a patient in their private residence. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board. Billing guidelines: Optum Behavioral Health will reimburse telehealth services which use standard CPT codes and a GT modifier or a Place of Service of 02 for Telehealth (also referred to as telemedicine) gives our members access to their health care provider from their home or another location. 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. Yes. When specific contracted rates are in place for diagnostic COVID-19 tests, Cigna will reimburse covered services at those contracted rates. The location where health services and health related services are provided or received, through telecommunication technology. The Outbreak Period is a period distinct from the COVID-19 public health emergency (PHE), which applies to other COVID-related relief measures, such as no-cost share coverage of COVID-19 testing. Note: This article was updated on January 26, 2022, for clarification purposes. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. In order to bill these codes, the test must be FDA approved or cleared or have received Emergency Use Authorization (EUA). Our mental health insurance billing staff is on call Monday Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy. Under normal circumstances, the provider would bill with the Place of Service code 2, to indicate the care was rendered via telehealth. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. 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. Modifier CS for COVID-19 related treatment. Cigna will not reimburse providers for the cost of the vaccine itself. What place of service code should be used for telemedicine services? COVID-19 admissions would be emergent admissions and do not require prior authorizations. All other customers will have the same cost-share as if they received the services in-person from that same provider. All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02. No waiting rooms. 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. 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. Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours. Are reasonable to be provided in a virtual setting; and, Are reimbursable per a providers contract; and, Use synchronous technology (i.e., audio and video) except 99441 - 99443, which are audio-only services, Most synchronous technology to be used (e.g., FaceTime, Skype, Zoom, etc. 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. We understand that it's important to actually be able to speak to someone about your billing. Cigna will reimburse providers the full allowed amount of the claim, including what would have been the customer's cost share. It's our goal to ensure you simply don't have to spend unncessary time on your billing. Yes. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. 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. Cigna follows CMS rules related to the use of modifiers. Emergent transport to nearby facilities capable of treating customers is covered without prior authorization. Urgent Care vs. the Emergency Room7 Ways to Help Pay Less for Out-of-Pocket Costs, What is Preventive Care?View all articles. Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. Federal government websites often end in .gov or .mil. 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. 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. 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. M0222 (administration in facility setting): $350.50, M0223 (administration in home setting): $550.50. Yes. Yes. MLN Matters article MM12427, New modifications to place of service (POS) codes for telehealth. Yes. 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). Issued by: Centers for Medicare & Medicaid Services (CMS). For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy. 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. This will allow for quick telephonic consultations related to COVID-19 screening or other necessary consults, and will offer appropriate reimbursement to providers for this amount of time. Place of Service (POS) equal to what it would have been had the service been provided in-person. This eases coordination of benefits and gives other payers the setting information they need. 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. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. This will help with tracking purposes, and ensure timely reimbursement for the administration of the treatment. Cigna will factor in the current strain on health care systems and will incorporate this information into retrospective reviews. The ICD-10 codes for the reason of the encounter should be billed in the primary position. Sign up to get the latest information about your choice of CMS topics. It must be initiated by the patient and not a prior scheduled visit. 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. POS codes are two-digit codes reported on . 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 . 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.
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