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). There may be limited exclusions based on the diagnoses submitted. Other place of service not identified above. Service performed: OEce or other outpatient visit for the evaluation and management of a new patient CPT code billed: 99202 Modier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): 100% of face-to-face rate Customer cost-share: Applies consistent with Note that billing B97.29 will not waive cost-share. No. Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF). representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462). Cigna will accept roster billing from providers who are already mass immunizers and bill Cigna today in this way for other vaccines (e.g., seasonal flu vaccine), as well as from providers and state agencies that are offering mass vaccinations for their local communities, provided the claim roster includes sufficient information to identify the Cigna customer. We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. identify telehealth or telephone (audio only) services that were historically performed in the office or other in person setting (E.g. PCR and antigen tests: U0001, U0002, U0003, U0004, U0005, 87426, 87428, 87635, 87636, 87637, and 87811. "All Rights Reserved." This website and its contents may not be reproduced in whole or in part without . If a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. 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. MLN Matters article MM12427, New modifications to place of service (POS) codes for telehealth. No. Yes. As private practitioners, our clinical work alone is full-time. 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. Therefore, we will not enforce an administrative denial for failure to secure authorization (FTSA)on appeal if an extenuating circumstance due to COVID-19 applied. These codes should be used on professional claims to specify the entity where service(s) were rendered. Hi Laelia, I'd be happy to help. While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. If a hospitalist is the treating provider, they would not be reimbursed for two services on the same day, as only one service is reimbursed per day, regardless of billing method. Area (s) of Interest: Payor Issues and Reimbursement. Providers could deliver any face-to-face service on their fee schedule virtually, including those not related to COVID-19, for dates of service through December 31, 2020. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. 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. Reimbursement for the administration of the injection will remain the same. Therefore, FaceTime, Skype, Zoom, etc. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. 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. For covered virtual care services cost-share will apply as follows: No. Customer cost-share will be waived for COVID-19 related virtual care services through at least. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Telehealth Provided Other than in Patients Home, Process for Requesting New Codes or Modification of Existing Codes, Place of Service Codes for Professional Claims (PDF), A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services to American Indians and Alaska Natives who do not require hospitalization. In these cases, the non-credentialed provider can bill under the group assuming they are practicing within state laws to administer the vaccine. 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 addition, Anthem would recognize telephonic-only . 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. Effective for dates of service on and after March 2, 2020 until further notice, Cigna will cover eConsults when billed with codes 99446-99449, 99451 and 99452 for all conditions. 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. Providers can, however, bill the vaccine code (e.g., 91300 for the Pfizer vaccine or 91301 for the Moderna vaccine) with a nominal charge (e.g., $.01), but it is not required to be billed in order to receive reimbursement for the administration of the vaccine. Medicare telehealth services practitioners use "02" if the telehealth service is delivered anywhere except for the patient's home. 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. 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. This code will only be covered where state mandates require it. 2 Limited to labs contracted with MDLIVE for virtual wellness screenings. Modifier CR or condition code DR can also be billed instead of CS. Please review our R33 COVID-19 Interim Billing Guidelines policy for ICD-10 diagnosis code requirements to have cost-share waived for G2012. Please review these changes by going to the Provider FastFax page and selecting fax number 30. This will help with tracking purposes, and ensure timely reimbursement for the administration of the treatment. We recommend providers bill POS 02 beginning July 1, 2022 for virtual services (instead of a face-to-face POS). The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. Because health care providers are the most trusted source of information for consumers who are hesitant about receiving the vaccine, we continue to encourage providers to proactively educate their patients especially those who may have vaccine hesitancy or who are at high-risk of severe COVID-19 illness on the safety, effectiveness, and availability of the vaccine. No waiting rooms. To this end, we will use all feedback we receive to consider further updates to our policy. Yes. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. Neither U0003 nor U0004 should be used for tests that are used to detect COVID-19 antibodies. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. We are committed to helping providers deliver care how, when, and where it best meets the needs of their patients. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. eConsult services remain covered; however, customer cost-share applies as of January 1, 2022. Organizations that offer Administrative Services Only (ASO) plans will be opted in to waiving cost-share for this service as well. Urgent care centers will not be reimbursed separately when they bill for multiple services. As of January 1, 2022, a new POS code has been approved to report more specifically where services were provided. POS 02: Telehealth Provided Other than in Patient's Home 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. These codes do not need a place of service (POS) 02 or modifier 95 or GT. As of July 1, 2022, we request that providers bill with POS 02 for all virtual care. Yes. When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9. When a claim is submitted by the facility the patient was transferred to (e.g., SNF, AR, or LTACH), the facility should note that the patient was transferred to them without an authorization in an effort to quickly to free up bed space for the transferring facility. Paid per contract; standard cost-share applies. Ultimately however, care must be medically necessary to be covered. No. 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. Under normal circumstances, the provider would bill with the Place of Service code 2, to indicate the care was rendered via telehealth. Similarly, if a cardiologist is brought in to consult in a face-to-face setting within a facility setting, that cardiologist can also provide services virtually billing a face-to-face evaluation and management (E&M) visit (the same code[s] on their fee schedule and the same claim form [e.g., CMS 1500 or UB-04]). 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, Urgent care centers to offer virtual care when billing with a global S9083 code, Most synchronous technology to be used (e.g., FaceTime, Skype, Zoom, etc. codes and normal billing procedures. Providers should bill this code for dates of service on or after December 23, 2021. 3. 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. What place of service code should be used for telemedicine services? 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. "Medicare hasn't identified a need for new POS code 10. We continue to make several other accommodations related to virtual care until further notice. All commercial Cigna plans (e.g., employer-sponsored plans) have customer cost-share for non-COVID-19 services. The ordering provider should use the standard, existing process to submit home health orders to eviCore healthcare. April 14, 2021. For a complete list of billing requirements, please review the Virtual Care Reimbursement Policy. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. means youve safely connected to the .gov website. What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. I cannot capture in words the value to me of TheraThink. Bill those services on a CMS-1500 form or electronic equivalent. No. Urgent Care vs. the Emergency Room7 Ways to Help Pay Less for Out-of-Pocket Costs, What is Preventive Care?View all articles. Refer to the Telemedicine Website for a list of billing codes which may be used with Place of Service (POS) 02 or 10. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. To speak with a dentist,log in to myCigna. Please visit CignaforHCP.com/virtualcare for additional information about that policy. 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. We are your billing staff here to help. It remains expected that the service billed is reasonable to be provided in a virtual setting. Instead U07.1, J12.82, M35.81, or M35.89 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnoses.Please refer to the general billing guidance for additional information. 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. You can call, text, or email us about any claim, anytime, and hear back that day. 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. Per usual policy, Cigna does not require three days of inpatient care prior to transfer to a SNF. They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually. Inpatient COVID-19 care that began on or before February 15, 2021, and continued on or after February 16, 2021 at the same facility, will have cost-share waived for the entire course of the facility stay. A facility maintained by either State or local health departments that provides ambulatory primary medical care under the general direction of a physician. Heres how you know. For example, if the Outbreak Period ends March 1, 2023, any service performed on or before that date will have its standard timely filing window begin upon the expiration of the Outbreak Period (here, March 1, 2023). Effective with January 1, 2021 dates of service, we implemented a new Virtual Care Reimbursement Policy. A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. ), Preventive care services (99381-99387 and 99391-99397), Skilled nursing facility codes (99307-99310) [Effective with January 29, 2022 dates of service]. Before sharing sensitive information, make sure youre on a federal government site. Here is a complete list of place of service codes: Place of Service Codes. 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. Yes. Services not related to COVID-19 will have standard customer cost-share.
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