A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. Refer to the Telemedicine Website for a list of billing codes which may be used with Place of Service (POS) 02 or 10. For telephone services only, codes are time based. If more than one telephone, Internet, or electronic health record contact(s) is required to complete the consultation request (e.g., discussion of test results), the entirety of the service and the cumulative discussion and information review time should be billed with a single code. 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. When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9. Cigna covers FDA EUA-approved laboratory tests. While we will not reimburse the drug itself when a provider receives it free of charge, we request that providers continue to bill the drug on the claim using the CMS code for the specific drug, along with a nominal charge (e.g., $.01), to assist with tracking purposes. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically Note that billing B97.29 will not waive cost-share. Comprehensive Outpatient Rehabilitation Facility. Subscribe now with just HK$100. This coverage began January 15, 2022 and continues through at least the end of the public health emergency (PHE) period (May 11, 2023). Telemedicine Billing Guide & CPT Codes | HealthLens PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. For telehealth, the 95 modifier code is used as well. Cigna does require prior authorization for fixed wing air ambulance transport. A facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services by, or under, the supervision of physicians to patients admitted for a variety of medical conditions. A location, not part of a hospital and not described by any other Place of Service code, that is organized and operated to provide preventive, diagnostic, therapeutic, rehabilitative, or palliative services to outpatients only. List the address of the physician for the telehealth visit on the CMS1500 claim. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility. Primary care physician referrals for specialist office visits were temporarily waived for Individual & Family Plans (IFP) in Illinois and for all SureFit plans through May 31, 2021. As of February 16, 2021 dates of service, these treatments remain covered, but with standard customer cost-share. 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. When multiple services are billed along with S9083, only S9083 will be reimbursed. ICD-10 diagnosis codes that generally reflect non-covered services are as follows. 1 In an emergency, always dial 911 or visit the nearest hospital. (As of 01/21/2021) What Common Procedural Technology (CPT) codes should be used for COVID-19 testing? A facility that provides the following services: outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically ill, and residents of the CMHC's mental health services area who have been discharged from inpatient treatment at a mental health facility; 24 hour a day emergency care services; day treatment, other partial hospitalization services, or psychosocial rehabilitation services; screening for patients being considered for admission to State mental health facilities to determine the appropriateness of such admission; and consultation and education services. 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). 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. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. When no specific contracted rates are in place, Cigna will reimburse all covered COVID-19 diagnostic tests consistent with CMS reimbursement to ensure consistent, timely, and reasonable reimbursement. * POS code 10 POS code name Comprehensive Inpatient Rehabilitation Facility. COVID-19: Billing & Coding FAQs for Aetna Providers Place of Service (POS) equal to what it would have been had the service been provided in-person. Per CMS, U0003 and U0004 should be used to bill for tests that would typically be billed by 87635 and U0002 respectively, except for when the tests are performed with these high-throughput technologies. Under My Account > Settings > Practice Details, you can select the Insurance Place of Service code associated with sessions held via video. A certified facility which is located in a rural medically underserved area that provides ambulatory primary medical care under the general direction of a physician. You free me to focus on the work I love!. We understand that it's important to actually be able to speak to someone about your billing. 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. 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. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. 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. PDF Telehealth/Telemedicine and Telephone Call (Audio Only) Frequently 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. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. PDF Telehealth/Telemedicine COVID-19 Billing Cheat Sheet - NC The 02 Place of Service code will automatically populate onto your courtesy claims and Superbills when the appointment is scheduled at that location. Cigna Telehealth Billing for Therapy and Mental Health Services The COVID-19 billing and reimbursement guidelines that follow are for commercial Cigna medical services, including IFP, unless otherwise noted. 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). This eases coordination of benefits and gives other payers the setting information they need. 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. eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. Cigna to Cover Virtual Care for PT, OT and SLP Under normal circumstances, the provider would bill with the Place of Service code 2, to indicate the care was rendered via telehealth. As of April 4, 2022, individuals with Medicare Part B and Medicare Advantage plans can get up to eight OTC tests per calendar month from participating pharmacies and health care providers for the duration of the COVID-19 public health emergency (PHE). As of January 1, 2022, a new POS code has been approved to report more specifically where services were provided. A medical facility operated by one or more of the Uniformed Services. Modifier CS for COVID-19 related treatment. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. 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. Insurance Reimbursement Rates for Psychotherapy, Insurance Reimbursement Rates for Psychiatrists, Beginners Guide To Mental Health Billing, https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf, guide on HIPAA compliant video technology for telehealth, https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf, Inquire about our mental health insurance billing service, offload your mental health insurance billing, We charge a percentage of the allowed amount per paid claim (only paid claims). How Can You Tell Which Specific Technology is Reimbursable? Learn about the medical, dental, pharmacy, behavioral, and voluntary benefits your employer may offer. There may be limited exclusions based on the diagnoses submitted. 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. While the R31 Virtual Care Reimbursement Policy that went into effect on January 1, 2021 only applies to claims submitted on a CMS-1500 claim form, we will continue to reimburse virtual care services billed on a UB-04 claim form until further notice when the services: Please note that existing reimbursement policies will apply and may affect claims payment (e.g., R30 E&M Services). End-Stage Renal Disease Treatment Facility. When specific contracted rates are in place for diagnostic COVID-19 tests, Cigna will reimburse covered services at those contracted rates. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. Intake / Evaluation (90791) Billing Guide, Evaluation with Medical Assessment (90792). Certain home health services can be provided virtually using synchronous communication as part of our R31 Virtual Care Reimbursement Policy. Place of Service 02 will reimburse at traditional telehealth rates. In order to bill these codes, the test must be FDA approved or cleared or have received Emergency Use Authorization (EUA). While as part of this policy, Urgent Care centers billing virtual care on a global S code is not reimbursable, we do continue to reimburse these services until further notice as part of our interim COVID-19 guidelines. A prison, jail, reformatory, work farm, detention center, or any other similar facility maintained by either Federal, State or local authorities for the purpose of confinement or rehabilitation of adult or juvenile criminal offenders. For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. In all cases, reimbursement will only be provided for hospital outpatient services performed in a clinic setting (including drive-thru testing sites) when billed on a UB-04 claim form with an appropriate revenue code. 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. Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually until further notice. Residential Substance Abuse Treatment Facility. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. Yes. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. We continue to monitor for any updates from the administration and are evaluating potential changes to our ongoing COVID-19 accommodations as a result of the PHE ending. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. This is true for Medicare or other insurance carriers. Effective with January 1, 2021 dates of service, we implemented a new Virtual Care Reimbursement Policy. New and revised codes are added to the CPBs as they are updated. While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). No. 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. lock Cigna will not reimburse providers for the cost of the vaccine itself. To this end, we will use all feedback we receive to consider further updates to our policy. Cigna offers a number of virtual care options depending on your plan. Service codes Physicians: use service codes 99441-99443; Non-physicians: use 98966-98968 We're waiving copays for telehealth visits for behavioral and mental health counseling for members eligible for managed long-term services and supports (MLTSS) and Division of Developmental . 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. Home Visit Codes New Patient: 99343 Established Patient: 99349 Place of Service (POS): 12 - Home Office Visit Codes New Patient: 99203 Established Patient: 99213 Place of Service (POS): 11 - Office Telephone Call Codes Established Patient: 99442 Place of Service (POS): 11 - Office Modifiers GQ - Store-and-forward (asynchronous) 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. Yes. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. Let us handle handle your insurance billing so you can focus on your practice. Yes. When the condition being billed is a post-COVID condition, please submit using ICD-10 code U09.9 and code first the specific condition related to COVID-19. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Services include physical therapy, occupational therapy, and speech pathology services. Cigna will generally not cover molecular, antigen, or antibody tests for asymptomatic individuals when the tests are performed for general population or public health surveillance, for employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. We are awaiting further billing instructions for providers, as applicable, from CMS. Audio-only encounters can be provided using the telephone evaluation and management codes (CPT codes. representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). 1 (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). 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. Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; 31, 2022. MLN Matters article MM12427, New modifications to place of service (POS) codes for telehealth. 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). 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. For more information, see the resources along the right-hand side of the screen. A facility, other than a patient's home, in which palliative and supportive care for terminally ill patients and their families are provided. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other . Area (s) of Interest: Payor Issues and Reimbursement. a listing of the legal entities 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. One of our key goals is to help customers connect to affordable, predictable, and convenient care anytime, anywhere. What place of service code should be used for telemedicine services? 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. The facility that the patient is being transferred to (e.g., SNF, AR, or LTACH) is responsible for notifying Cigna of admissions the next business day. It's our goal to ensure you simply don't have to spend unncessary time on your billing. Urgent care centers can bill their global S code when a significant and separately identifiable service is performed at the same time as the administration of the vaccine, but will only be reimbursed for both services when their contract allows it (similar to how they may be reimbursed today for flu shot administration). Update to the telehealth Place of Service (POS) code Telehealth continues to be an integral part of providing safe and convenient health care visits for Medicare Advantage beneficiaries. Cigna will allow reimbursement for these codes by any provider or facility only when billed without any other codes (except where the contract allows it). 3 Biometric screening experience may vary by lab. 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. Heres how you know. 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. Place of Service - SimplePractice Support 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 Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF). When a state allows an emergent temporary provider licensure, Cigna will allow providers to practice in that state as participating if a provider is already participating with Cigna, is in "good standing," and if state regulations allow such care to take place. If a provider was reimbursed for a face-to-face service per their existing fee schedule, then they were reimbursed the same amount even if they delivered the service virtually. Providers receive reasonable reimbursement consistent with national CMS rates for administering EUA-approved COVID-19 vaccines. 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. Cost-share was waived through February 15, 2021 dates of service. 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). Cigna will allow direct emergent or urgent transfers from an acute inpatient facility to a second acute inpatient facility, skilled nursing facility (SNF), acute rehabilitation facility (AR), or long-term acute care hospital (LTACH). 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. ICD-10 code U07.1, J12.82, M35.81, or M35.89. Modifier CR or condition code DR can also be billed instead of CS. 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. We will also continue to consider Centers for Medicare & Medicaid (CMS) guidance, industry standards, and affordability for our clients to help inform any potential future changes to our reimbursement approach. While we encourage providers to bill virtual care consistent with an office visit and understand that certain services can be time consuming and complex even when provided virtually we strongly encourage providers to be cognizant when billing level four and five codes for virtual services. Virtual care offered by Urgent Care Centers billing with code S9083 is reimbursable until further notice. My cost is a percentage of what is insurance-approved and its my favorite bill to pay each month! incorporated into a contract. We do not expect smaller laboratories or doctors' offices to be able to perform these tests. Yes. In 2017, Cigna launched behavioral telehealth sessions for all their members. Certain virtual care services that were previously covered on an interim basis as part of our COVID-19 guidelines are now permanently covered as part of our Virtual Care Reimbursement Policy. Activate your myCigna account nowto get access to a virtual dentist. Telemedicine Billing Manual - Colorado 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). Talk to a licensed dentist via a video call, 24/7/365. As of April 1, 2021, Cigna resumed standard authorization requirements. Providers billing under an 837P/1500 must include the place of service (POS) code 02 when submitting claims for services delivered via telehealth. Evernorth Provider - Resources - COVID-19: Interim Guidance Cigna covers diagnostic antibody tests when 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). Therefore, your patients with Cigna commercial coverage can purchase OTC tests from a health care provider and seek reimbursement by billing Cigna directly following our published guidance. Cigna may request the appropriate CLIA-certification or waiver as well as the manufacturer and name of the test being performed. 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. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. Yes. PDF FAQs for Illinois Medicaid Virtual Healthcare Expansion/Telehealth All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. No. 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. The change in the telehealth policy will take effect on January 1, 2022, and be implemented on April 4, 2022. Yes. This is an extenuating circumstance. Cigna may not control the content or links of non-Cigna websites. No additional modifiers are necessary. Inflammation, sores or infection of the gums, and oral tissues, Guidance on whether to seek immediate emergency care, Board-certified dermatologists review pictures and symptoms; prescriptions available, if appropriate, Care for common skin, hair and nail conditions including acne, eczema, psoriasis, rosacea, suspicious spots, and more, Diagnosis and customized treatment plan, usually within 24 hours. Providers who are administering the COVID-19 vaccine in a site other than their typical office or facility setting (e.g., at a sports complex) can bill us under their regular facility location. Please review the Virtual care services frequently asked questions section on this page for more information. PDF CIGNA'S VIRTUAL CARE REIMBURSEMENT POLICY - MetroCare Physicians In addition, Anthem would recognize telephonic-only . Throughout the pandemic, the emergency use authorized monoclonal antibody drug bebtelovimab was purchased by the federal government and offered to providers for free. 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. Get non-narcotic prescriptions sent directly to your local pharmacy, if appropriate. Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours. 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. When no specific contracted rates are in place, Cigna will reimburse all covered COVID-19 diagnostic tests consistent with CMS reimbursement to ensure consistent, timely, and reasonable reimbursement. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. 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. Diluents are not separately reimbursable in addition to the administration code for the infusion. 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. Yes. 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. The POS Workgroup is revising the description of POS code 02 and creating a new POS code 10 to meet the overall industry needs, as follows: 1.