MLN Matters article MM12549, CY2022 telehealth update Medicare physician fee schedule. Virtual care offered by Urgent Care Centers billing with code S9083 is reimbursable until further notice. 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. 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). Reimbursement will be consistent as though they performed the service in a face-to-face setting. Standard cost-share will apply for the customer, unless waived by state-specific requirements. One of our key goals is to help your patients connect to affordable, predictable, and convenient care anytime, anywhere. 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. How Can You Tell Which Specific Technology is Reimbursable? The covered procedure codes for E-visits/online portal services include: 99421, 99422, 99423, G2061, G2062, G2063. Please note that state mandates and customer benefit plans may supersede our guidelines. Per usual protocol, emergency and inpatient imaging services do not require prior authorization. These codes should be used on professional claims to specify the entity where service (s) were rendered. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing. Certain home health services can be provided virtually using synchronous communication as part of our R31 Virtual Care Reimbursement Policy. For more information, see the resources along the right-hand side of the screen. This will help us to meet customers' clinical needs and support safe discharge planning. Cigna commercial and Cigna Medicare Advantage customers receive the COVID-19 vaccine with no out-of-pocket costs; and. Please note that while Cigna Medicare Advantage plans do fully cover the costs for COVID-19 tests done in a clinical setting, costs of at-home COVID-19 tests are not a covered benefit. M misstigris Networker Messages 63 Location Portland, OR We will continue to assess the situation and adjust to market needs as necessary. If specimen collection and a laboratory test are billed together, only the laboratory test will be reimbursed. Cigna will factor in the current strain on health care systems and will incorporate this information into retrospective reviews. Update to the telehealth Place of Service (POS) code - Aetna CHCP - Resources - Virtual Care - Cigna 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). Yes. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 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). The provider will need to code appropriately to indicate COVID-19 related services. 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. Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. Because most standard Cigna client benefit plans do not extend coverage to screening services when performed for employment reasons (e.g., occupational physical examination), virtual care screening services will generally not be covered solely for return-to-work purposes. For example, if a dietician or occupational therapist would typically see a patient in an outpatient setting, but that service is now provided virtually, that dietician or occupational therapist would bill the same way they do for that face-to-face visit using the existing codes on their fee schedule and existing claim form they typically bill with (e.g., CMS 1500 or UB-04) and append the GQ, GT, or 95 modifier. COVID-19 Reimbursement Guidelines - Provider Express As of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. 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. 2 Limited to labs contracted with MDLIVE for virtual wellness screenings. Contracted providers cannot balance bill customers for non-reimbursable codes. April 14, 2021. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. Yes. For costs and details of coverage, review your plan documents or contact a Cigna representative. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. For services included in our Virtual Care Reimbursement Policy, a number of general requirements must be met for Cigna to consider reimbursement for a virtual care visit. As always, we remain committed to ensuring that: Yes. New and revised codes are added to the CPBs as they are updated. When specific contracted rates are in place for COVID-19 specimen collection services, Cigna will reimburse covered services at those contracted rates. All synchronous technology used must be secure and meet or exceed federal and state privacy requirements. Please note that cost-share still applies for all non-COVID-19 related services. 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. Providers will continue to be reimbursed at 100% of face-to-face rates when billing POS 02. 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 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. For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. ICD-10 diagnosis codes that generally reflect non-covered services are as follows. 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. 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. All health insurance policies and health benefit plans contain exclusions and limitations. Modifier appended to billed code: 95, GT, or GQ Place of service billed: 11 Technology used: Audio and video Reimbursement received (if covered): . Area (s) of Interest: Payor Issues and Reimbursement. for services delivered via telehealth. Audio -only CPT codes 98966 98968 and 99441 We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. A facility for the diagnosis and treatment of mental illness that provides a planned therapeutic program for patients who do not require full time hospitalization, but who need broader programs than are possible from outpatient visits to a hospital-based or hospital-affiliated facility. HIPAA requirements apply to video telehealth sessions so please refer to our guide on HIPAA compliant video technology for telehealth to ensure youre meeting the requirements. Billing the appropriate administration code will ensure that cost-share is waived. Hi Laelia, I'd be happy to help. On Aug. 3, 2020 CMS published a revision to the April 27th, 2020 memo announcing the addition of telephonic CPT codes (98966-98968, 99441-99443) valid for 2020 benefit year data submissions for the Department of Health and Human Services- (HHS-) operated risk adjustment program. We do not expect smaller laboratories or doctors' offices to be able to perform these tests. Cigna understands the tremendous pressure our healthcare delivery systems are under. 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). Cigna will only cover non-diagnostic PCR, antigen, and serology (i.e., antibody) tests when covered by the client benefit plan. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. Is Face Time allowed? 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. 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 (whether billed on the same or different claims). Share sensitive information only on official, secure websites. PT/OT/ST providers could deliver virtual care for any service that was on their fee schedule for dates of service through December 31, 2020. Cigna covers FDA EUA-approved laboratory tests. Mid-level practitioners (e.g., physician assistants and nurse practitioners) can also provide services virtually using the same guidance. Telehealth Reimbursement Alert: 2022 Telehealth CPT Codes Released Live-guided relaxation by telephone Available for all providers at no cost Every Tuesday at 5:00pm ET Call 866.205.5379, enter passcode 113 29 178, and then press # Additional Resources Cigna Medicare Billing guidelines and telehealth Cigna Dental Interim Communication to Providers QualCare Workers Compensation Interim billing guidance 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. Yes. Maybe. Therefore, as of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment. Schedule an appointment online with MDLIVE and visit a lab for your blood work and biometrics. Cigna Telehealth Service No. Non-residential Substance Abuse Treatment Facility, Non-residential Opioid Treatment Facility, A location that provides treatment for opioid use disorder on an ambulatory basis. For services provided through February 15, 2021, providers will need to bill consistent with our interim billing guidelines by including the Diagnosis code (Dx) U07.1, J12.82, M35.81, or M35.89 on claims related to the treatment of COVID-19. 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 . October Update: Waivers, NCDs, and POS - AAPC Knowledge Center This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. Please visit CignaforHCP.com/virtualcare for additional information about that policy. As of January 1, 2022, a new POS code has been approved to report more specifically where services were provided. Effective Jan 1, 2022, the CMS changed the definition of POS code 02 we've been using for telehealth, and introduced a second telehealth POS code 10: POS 10: Telehealth to a client located at home (does not apply to clients in a hospital, nursing home or assisted living facility) POS 02: Telehealth to a client who is not located at home 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. Yes. A short term accommodation such as a hotel, camp ground, hostel, cruise ship or resort where the patient receives care, and which is not identified by any other POS code. Place of Service (POS) equal to what it would have been had the service been provided in-person. 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. lock Guide to Insurance Billing Codes: ICD 10, CPT, G Codes Cigna continues to reimburse participating providers when they are credentialed to practice medicine per state regulations, have a current contract, and have completed the Cigna credentialing process.Non-participating providers will only be reimbursed if: Yes. 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. Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed. 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. If you are rendering services as part of a facility (i.e., intensive outpatient program . Cigna Telehealth Service is a one-stop mobile app for having virtual consultation with doctors in Hong Kong as well as getting Covid-19 self-test kit & medication delivered to your doorstep. No additional credentialing or notification to Cigna is required. For dates of service beginning July 1, 2022, Cigna will apply a 2% payment adjustment.