Urgent care centers can also bill their typical S9083 code for services that are more complex than a quick telephone call. 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. codes and normal billing procedures. Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. A location which provides treatment for substance (alcohol and drug) abuse on an ambulatory basis. However, providers are required to attest that their designated specialty meets the requirements of Cigna. It must be initiated by the patient and not a prior scheduled visit. . State and federal mandates, as well as customer benefit plan designs, may supersede our guidelines. Please review these changes by going to the Provider FastFax page and selecting fax number 30. Services include physical therapy, occupational therapy, and speech pathology services. Treatment is supportive only and focused on symptom relief. 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). For a complete list of billing requirements, please review the Virtual Care Reimbursement Policy. 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. 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. A provider should bill on the same form they usually do (e.g., CMS 1500 or UB-04) as when they provide the service face-to-face. Please note that some opt-outs for self-funded benefit plans may have applied. 97802, 97803, 97804) but require you to change the Place of Service Code to 02 for telehealth. Cigna will not make any limitation as to the place of service where an eConsult can be used. For more information, please visit Cigna.com/Coronavirus. First Page. Cigna does require prior authorization for fixed wing air ambulance transport. Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. 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. 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. These resources offer access to live-guided relaxation sessions, wellness podcasts, and wellness and stress management flyers. Yes. Yes. Important notes: For additional information about Cigna's coverage of medically necessary diagnostic COVID-19 tests, please review the COVID-19 In Vitro Diagnostic Testing coverage policy. Telephone, Internet, or electronic health record consultations of less than five minutes should not be billed. Telehealth claims with any other POS will not be considered eligible for reimbursement. 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. Cigna may not control the content or links of non-Cigna websites. No. 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. (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. In compliance with federal agency guidance, however, Cigna covers individualized COVID-19 diagnostic tests without cost-share through at least May 11, 2023 for asymptomatic individuals when referred by or administered by a health care provider. Effective January 1, 2022, eConsults remain covered, but cost-share applies for all covered services. Yes. Additionally, when you bill POS 02, your patients may also pay a lower cost-share for the virtual services they receive due to a recent change in some plan benefits. If an urgent care center performs an evaluation and treatment service, collects a specimen for COVID-19, and runs the laboratory test, they should bill just their per-visit S9083 code or just the laboratory code. For the immediate future, we will continue to reimburse virtual care services consistent with face-to-face rates. A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. The Administration's plan is to end the COVID-19 public health emergency (PHE) on May 11, 2023. We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. 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. Congregate residential facility with self-contained living units providing assessment of each resident's needs and on-site support 24 hours a day, 7 days a week, with the capacity to deliver or arrange for services including some health care and other services. Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. The ICD-10 codes for the reason of the encounter should be billed in the primary position. A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents who do not require acute medical care. 1995-2020 by the American Academy of Orthopaedic Surgeons. 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). Intermediate Care Facility/ Individuals with Intellectual Disabilities. Providers billing under an 837P/1500 must include the place of service (POS) code 02 when submitting claims for services delivered via telehealth. The site is secure. On January 1, 2021, we implemented a Virtual Care Reimbursement Policy that ensures permanent coverage of certain virtual care services. Talk to board-certified dermatologists without an appointment for customized care for skin, hair, and nail conditions. https:// Denny has interviewed hundreds of mental health practitioners to better understand their struggles and solutions, all with the goal of making the professional side of behavioral health a little easier, faster, and less expensive. 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). Primary care physician to specialist requesting input from a cardiologist, psychiatrist, pulmonologist, allergist, dermatologist, surgeon, oncologist, etc. Cost-share will be waived for COVID-19 related services only when providers bill the appropriate ICD-10 code and modifier CS. There are two primary types of tests for COVID-19: A serology (i.e., antibody) test for COVID-19 is considered diagnostic and covered without cost-share through at least May 11, 2023 when ALL of the following criteria are met: When specific contracted rates are in place for diagnostic COVID-19 serology tests, Cigna will reimburse covered services at those contracted rates. Yes. Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; No additional modifiers are necessary to include on the claim. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans. Providers should bill one of the above codes, along with: No. This form can be completed here:https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf. The change in the telehealth policy will take effect on January 1, 2022, and be implemented on April 4, 2022. There may be limited exclusions based on the diagnoses submitted. Providers can bill code G2012 for a quick 5-10 minute phone conversation as part of our R31 Virtual Care Reimbursement Policy, with cost-share waived through at least May 11, 2023 for customers when the conversation is related to COVID-19. Speak with a provider online and discuss your lab work, biometric screenings. As a reminder, standard customer cost-share applies for non-COVID-19 related services. (This code is available for use effective January 1, 2013 but no later than May 1, 2013), A portion of an off-campus hospital provider based department which provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services to sick or injured persons who do not require hospitalization or institutionalization. Refer to the Telemedicine Website for a list of billing codes which may be used with Place of Service (POS) 02 or 10. For dates of service February 4, 2020 through February 15, 2021, Cigna covered COVID-19 treatments without customer cost-share. The Center for Medicare and Medicaid Services (CMS) has announced that there is to be a change in the telehealth place of service (POS) code for billing Medicare and Medicaid Services. April 14, 2021. Yes. Therefore, FaceTime, Skype, Zoom, etc. 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. We do not expect smaller laboratories or doctors' offices to be able to perform these tests. When no contracted rates are in place, Cigna will reimburse covered diagnostic serology laboratory tests consistent with CMS reimbursement, including $42.13 for code 86769 and $45.23 for code 86328, to ensure consistent, timely, and reasonable reimbursement. Cigna will determine coverage for each test based on the specific code(s) the provider bills. A walk-in health clinic, other than an office, urgent care facility, pharmacy or independent clinic and not described by any other Place of Service code, that is located within a retail operation and provides, on an ambulatory basis, preventive and primary care services. Generally, only well-equipped commercial laboratories and hospital-based laboratories will have the necessary equipment to offer these tests. While Cigna does not require any specific placement for COVID-19 diagnosis codes on a claim, we recommend providers include the COVID-19 diagnosis code for confirmed or suspected COVID-19 patients in the first position when the primary reason the patient is treated is to determine the presence of COVID-19. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. ICD-10 code U07.1, J12.82, M35.81, or M35.89. bill a typical face-to-face place of service (e.g., POS 11) . Please note that state mandates and customer benefit plans may supersede our guidelines. Must be performed by a licensed provider. For all virtual care services, providers should bill using a reimbursable face-to-face code, append the GQ, GT or 95 modifier, and use POS 02 as of July 1, 2022. Yes. If the telephone, Internet, or electronic health record consultation leads to a transfer of care or other face-to-face service (e.g., a surgery, a hospital visit, or a scheduled office evaluation of the patient) within the next 14 days or next available appointment date of the consultant, these codes should not be billed. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. 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. Subscribe now with just HK$100. U.S. Department of Health & Human Services You can call, text, or email us about any claim, anytime, and hear back that day. 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. Ultimately however, care must be medically necessary to be covered. 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. This code will only be covered where state mandates require it. 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. "Medicare hasn't identified a need for new POS code 10. Concurrent review will start the next business day with no retrospective denials. An air or water vehicle specifically designed, equipped and staffed for lifesaving and transporting the sick or injured. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. Please visit. 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.