Considering the pressure facilities are under, Cigna will extend the authorization approval window from three months to six months on request. 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 understand that it's important to actually be able to speak to someone about your billing. Speak with a provider online and discuss your lab work, biometric screenings. Billing an evaluation and management (E/M) code when that level of service is not provided is fraudulent billing and is expressly prohibited. However, this added functionality is planned for a future update. A freestanding facility, other than a physician's office, where surgical and diagnostic services are provided on an ambulatory basis. Residential Substance Abuse Treatment Facility. Modifier CS for COVID-19 related treatment. This code will only be covered where state mandates require it. When no specific contracted rates are in place, Cigna will reimburse the administration of all covered COVID-19 vaccines at the established national CMS rates noted below when claims are billed under the medical benefit to ensure timely, consistent, and reasonable reimbursement. No. These codes should be used on professional claims to specify the entity where service(s) were rendered. To this end, we appreciate the feedback and deep collaboration weve had with provider groups and medical societies regarding virtual care. eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. 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. DISCLAIMER: The contents of this database lack the force and effect of law, except as You can call, text, or email us about any claim, anytime, and hear back that day. 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. Providers should bill this code for dates of service on or after December 23, 2021. In addition, Anthem would recognize telephonic-only . Diluents are not separately reimbursable in addition to the administration code for the infusion. Transport between facilities such as hospitals and SNFs and hospitals and Acute Rehab centers is also covered without prior authorization. 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. No. What codes would be appropriate to consider for telehealth (audio and video) for physical, occupational, and speech therapies? 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. Cigna has not lifted precertification requirements for scheduled surgeries. 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. A facility, other than a hospital's maternity facilities or a physician's office, which provides a setting for labor, delivery, and immediate post-partum care as well as immediate care of new born infants. 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. To increase convenient 24/7 access to care if a patients preferred provider is unavailable in-person or virtually, our virtual care platform also offers solutions that include national virtual care vendors like MDLive. Other place of service not identified above. Cigna allowed providers to bill a standard face-to-face visit for all virtual care services, including those not related to COVID-19, through December 31, 2020 dates of service. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with CMS reimbursement to ensure timely, consistent and reasonable reimbursement. Denny and his team are responsive, incredibly easy to work with, and know their stuff. The test is FDA approved or cleared or have received Emergency Use Authorization (EUA); The test is run in a laboratory, office, urgent care center, emergency room, drive-thru testing site, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU. Cigna will not reimburse providers for the cost of the vaccine itself. Yes. Patient is not located in their home when receiving health services or health related services through telecommunication technology. Audio -only CPT codes 98966 98968 and 99441 End-Stage Renal Disease Treatment Facility. 3. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically For more information, please visit Cigna.com/Coronavirus. Sign up to get the latest information about your choice of CMS topics. These codes are used to report episodes of patient care initiated by an established patient or guardian of an established patient. Services performed on and after March 1, 2023 would have just their standard timely filing window. Approximately 98% of reviews are completed within two business days of submission. Similar to non-diagnostic COVID-19 testing services, Cigna will only cover non-diagnostic return-to-work virtual care services when covered by the client benefit plan. 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. 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. 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. Telehealth (also referred to as telemedicine) gives our members access to their health care provider from their home or another location. We are actively reviewing all COVID-19 state mandates and will continue to share any changes and more details around coverage, reimbursement, and cost-share as applicable. Further, we will 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. 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. These include: Virtual preventive care, routine care, and specialist referrals. 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. 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. Cigna currently allows for the standard timely filing period plus an additional 365 days. 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. Yes. 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. Reimbursement, when no specific contracted rates are in place, are as follows: No. Yes. 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. For example, if a patient presents at an emergency room with a suspected broken ankle after a fall and is also tested for COVID-19 during the visit, Cigna would cover services related to treating the ankle at standard customer cost-share, while the COVID-19 laboratory test would be covered at no customer cost-share. 24/7, live and on-demand for a variety of minor health care questions and concerns. Yes. 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. 200 Independence Avenue, S.W. For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. 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. Telephone, Internet, or electronic health record consultations of less than five minutes should not be billed. 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). A facility maintained by either State or local health departments that provides ambulatory primary medical care under the general direction of a physician. For additional information about our coverage of the COVID-19 vaccine, please review our. We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary. Providers should bill the relevant vaccine administration code (e.g., 0001A, 0002A, etc.) Through this feedback and research, we developed a list of covered services that we believe are most appropriate to be offered virtually across multiple specialties. for services delivered via telehealth. (This code is effective January 1, 2022, and available to Medicare April 1, 2022.). When billing for the service, indicate the place of service as where the visit would have occurred if in person. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. Listed below are place of service codes and descriptions. Important notes, What the accepting facility should know and do. 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 Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. 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. This coverage began January 15, 2022 and continues through at least the end of the public health emergency (PHE) period (May 11, 2023). This policy applied to customers in the United States who are covered under Cigna's employer/union sponsored insured group health plans, insured plans for US-based globally mobile individuals, Medicare Advantage, and Individual and Family Plans (IFP). You want to get paid quickly, in full, and not have to do more than spend 10 or 15 minutes to input your weekly calendar. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. Please review our R33 COVID-19 Interim Billing Guidelines policy for ICD-10 diagnosis code requirements to have cost-share waived for G2012. Product availability may vary by location and plan type and is subject to change. Locations may have included hospitals, rehabilitation centers, skilled nursing facilities, temporary hospitals, or any other facility where treatment is generally provided. Store and forward communications (e.g., email or fax communications) are not reimbursable. No. Cigna covers C9803 with no customer cost-share for a hospital outpatient clinic visit specimen collection, including drive-thru tests, through at least May 11, 2023 only when billed without any other codes. Subscribe now with just HK$100. 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). Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022