cigna telehealth place of service code
This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. These codes should be used on professional claims to specify the entity where service (s) were rendered. Therefore, please refer to those guidelines for services rendered prior to January 1, 2021. For telephone services only, codes are time based. Treatment is supportive only and focused on symptom relief. 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). Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. Please note, however, that we consider a providers failure to request an authorization due to COVID-19 an extenuating circumstance in the same way we view care provided during or immediately following a natural catastrophe (e.g., hurricane, tornado, fires, etc.). Listed below are place of service codes and descriptions. a listing of the legal entities In addition to the in-office care that you deliver today, we encourage you to consider offering virtual care to your patients with Cigna coverage as well and ensure theyre aware that you can continue to offer ongoing covered virtual care as they need it and as its medically appropriate. Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance. We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. A facility or location, owned and operated by the Indian Health Service, which provides diagnostic, therapeutic (surgical and non-surgical), and rehabilitation services rendered by, or under the supervision of, physicians to American Indians and Alaska Natives admitted as inpatients or outpatients. Please review the Virtual care services frequently asked questions section on this page for more information. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. 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. Per usual protocol, emergency and inpatient imaging services do not require prior authorization. Beginning January 15, 2022, and through at least the end of the PHE (. If an urgent care center administers a quick uniform screening (questionnaire) that does not result in a full evaluation and management service of any level and then performs a COVID-19 test OR a collection service, they should bill only the laboratory code OR collection code. 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. Billing the appropriate administration code will ensure that cost-share is waived. 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. 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. 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. List the address of the physician for the telehealth visit on the CMS1500 claim. When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. 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 This means that providers could perform services for commercial Cigna medical customers in a virtual setting and bill as though the services were performed face-to-face. All Cigna pharmacy and medical plans will cover Paxlovid and molnupiravir at any pharmacy or doctors office (in- or out-of-network) that has them available. If the patient is in their home, use "10". For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. 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. You can call, text, or email us about any claim, anytime, and hear back that day. Cigna will reimburse at 100% of face-to-face rates, even when billing POS 02. Cigna Telehealth CPT Codes: Please ensure the CPT code you use is the most accurate depiction of services rendered. No. 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. Providers billing under an 837P/1500 must include the place of service (POS) code 02 when submitting claims for services delivered via telehealth. Cigna will also administer the waiver for self-insured group health plans and the company encourages widespread participation, although these plans will have an opportunity to opt-out of the waiver option or opt-in to extend the waiver past February 15, 2021. Yes. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. were all appropriate to use through December 31, 2020. Place of Service Code Set. Area (s) of Interest: Payor Issues and Reimbursement. In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates. were all appropriate to use). Yes, the cost-share waiver for COVID-19 treatment ended on February 15, 2021. 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. 3 Biometric screening experience may vary by lab. 1. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 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. Cost-share is waived only when billed by a provider or facility without any other codes. A facility that provides inpatient psychiatric services for the diagnosis and treatment of mental illness on a 24-hour basis, by or under the supervision of a physician. Download and . 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. We will continue to assess the situation and adjust to market needs as necessary. We covered codes 99441-99443 as part of these interim COVID-19 guidelines, and continue to cover them as part of the R31 Virtual Care Reimbursement Policy. Hi Laelia, I'd be happy to help. Let us handle handle your insurance billing so you can focus on your practice. "Medicare hasn't identified a need for new POS code 10. Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. Consistent with federal guidelines for private insurers, Cigna commercial will cover up to eight over-the-counter (OTC) diagnostic COVID-19 tests per month (per enrolled individual) with no out-of-pocket costs for claims submitted by a customer under their medical benefit. In addition, Cigna recognizes and expects that providers will continue to follow their usual business practices regarding onboarding new providers, locum tenens, and other providers brought in to cover practices or increase care during times of high demand. This is true for Medicare or other insurance carriers. 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). This Change Request implements a new POS code (10) for Telehealth, as well as modifies the description for the existing POS code (02) for Telehealth. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, and psychological testing. Our data is encrypted and backed up to HIPAA compliant standards. Yes. Free Account Setup - we input your data at signup. Place of Service 02 in Field 24-B (see sample claim form below) For illustrative purposes only. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Cigna currently allows for the standard timely filing period plus an additional 365 days. You want to know you can call your billing admin, a real person you've already spoken with, and get immediate answers about your claims. It must be initiated by the patient and not a prior scheduled visit. Claims were not denied due to lack of referrals for these services during that time. ), but the patient is also tested for COVID-19 for diagnostic reasons, the provider should bill the diagnosis code specific to the primary reason for the encounter in the first position, and the COVID-19 diagnosis code in any position after the first. Must be performed by a licensed provider. 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. We maintain all current medical necessity review criteria for virtual care at this time. As private practitioners, our clinical work alone is full-time. Reimbursement for the administration of the injection will remain the same. 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. This new initiative enables payment from original Medicare for submitted claims directly to participating eligible pharmacies and other health care providers, which allows Medicare beneficiaries to receive tests at no cost. 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. 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. Free Account Setup - we input your data at signup. No authorization is required for the procurement or administration of COVID-19 infusion treatments. Generally, this means routine office, urgent care, and emergency visits do not require prior authorization. As always, we remain committed to ensuring that: Yes. Codes 99441-99443 are non-face-to-face E/M services provided to a patient using the telephone by a physician or other QHP who may report E/M services. Military Treatment Facility (MTF) also refers to certain former U.S. Public Health Service (USPHS) facilities now designated as Uniformed Service Treatment Facilities (USTF). ) New/Modifications to the Place of Service (POS) Codes for Telehealth This Change Request implements a new POS code (10) for Telehealth, as well as modifies the description for the existing POS code (02) for Telehealth. 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). Residential Substance Abuse Treatment Facility. 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. We continue to make several other accommodations related to virtual care until further notice. TheraThink.com 2023. Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. Cigna remains adequately staffed to respond to all new precertification requests for elective procedures within our typical timelines. Reimbursement for codes that are typically billed include: Yes. Until further notice, we will continue to made additional virtual care accommodations by allowing: eConsults are when a treating health care provider seeks guidance from a specialist physician through electronic means (e.g., phone, Internet, EHR consultation) to help manage care that is beyond the treating health care provider's usual practice.Typical examples include: Yes. 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. Eligibility & Benefits Verification (in 2 business days), EAP / Medicare / Medicaid / TriCare Billing, Month-by-Month Contract: No risk trial period. As of February 16, 2021 dates of service, these treatments remain covered, but with standard customer cost-share. Unlisted, unspecified and nonspecific codes should be avoided. 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. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. End-Stage Renal Disease Treatment Facility. Preventive care checkups and wellness screenings available at no additional cost, Routine care visits allow you to build a relationship with the same primary care provider (PCP) to helpmanage conditions, Prescriptions available through home delivery orat local pharmacies, if appropriate, Receive orders for biometrics, blood work andscreenings at local facilities, Skin conditions such as rashes, moles, eczema, and psoriasis, Care for hundreds of minor medical conditions, A convenient and affordable alternative to urgent, Schedule an appointment that works for you, You have the option to select the same provider for every session, Get prescriptions sent directly to your local pharmacy, if appropriate. Non-contracted providers should use the Place of Service code they would have used had the . 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. Billing Guidelines: Optum will reimburse telehealth services which use standard CPT codes for outpatient treatment and a GT, GQ or 95 modifier for either a video-enabled virtual visit or a telephonic session, to indicate the visit was conducted remotely. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. or Secure .gov websites use HTTPSA A laboratory certified to perform diagnostic and/or clinical tests independent of an institution or a physician's office. codes and normal billing procedures. 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. We are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. POS 02: Telehealth Provided Other than in Patient's Home 31, 2022. You'll always be able to get in touch. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. Recent guidelines have recommended keeping the normal service facility that you are registered under in your CMS-1500. Specimen collection is not generally paid in addition to other services on the same date of service for the same patient whether billed on the same or different claims by the same provider. This generally takes place in a mass immunization setting, such as, a public health center, pharmacy, or mall but may include a physician office setting. Additionally, certain virtual care services and accommodations that are not generally reimbursable under the Virtual Care Reimbursement Policy remain reimbursable as part of our continued interim COVID-19 virtual care guidelines until further notice. While Cigna doesn't require further credentialing or license validation, and the provider can work under the scope of their license, providers are encouraged to inform Cigna when they will practice across state lines. All other customers will have the same cost-share as if they received the services in-person from that same provider. A residence, with shared living areas, where clients receive supervision and other services such as social and/or behavioral services, custodial service, and minimal services (e.g., medication administration).