Introducing Parachute Rx: A program for your uninsured and unemployed patients, offering deeply discounted generic and non-generic medications. 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. 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, Most synchronous technology to be used (e.g., FaceTime, Skype, Zoom, etc. Beginning January 15, 2022, and through at least the end of the PHE (. 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). Cigna commercial and Cigna Medicare Advantage will waive the authorization requirement for facility-to-facility transfers from December 12, 2022 through March 15, 2023. This includes providers who typically deliver services in a facility setting. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person. Federal government websites often end in .gov or .mil. Therefore, please refer to those guidelines for services rendered prior to January 1, 2021. An E&M service and COVID-19 vaccine administration code should only be billed when a significant and separately identifiable E&M visit was performed at the same time as the administration of the vaccine. A facility which provides room, board and other personal assistance services, generally on a long-term basis, and which does not include a medical component. While we will not reimburse the drug itself when a provider receives it free of charge, we request that providers continue to bill the drug on the claim using the CMS code for the specific drug, along with a nominal charge (e.g., $.01), to assist with tracking purposes. Cigna has not lifted precertification requirements for scheduled surgeries. Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004. Issued by: Centers for Medicare & Medicaid Services (CMS). When no specific contracted rates are in place, Cigna will reimburse the administration of all emergency use authorized (EUA) vaccines at the established national, Cigna will reimburse vaccinations administered in a home setting an additional $35.50 per dose consistent with the established national. Billing the appropriate administration code will ensure that cost-share is waived. When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance. These resources offer access to live-guided relaxation sessions, wellness podcasts, and wellness and stress management flyers. Total 0 Results. Yes. Services include physical therapy, occupational therapy, and speech pathology services. Psychiatric Facility-Partial Hospitalization. Yes. No. Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. Transport between facilities such as hospitals and SNFs and hospitals and Acute Rehab centers is also covered without prior authorization. Summary of Codes for Use During State of Emergency. Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. Yes. For other laboratory tests when COVID-19 may be suspected. No. Yes. Yes. Download the Guidance Document Final Issued by: Centers for Medicare & Medicaid Services (CMS) Issue Date: May 27, 2022 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. 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). Subscribe now with just HK$100. Speak with a provider online and discuss your lab work, biometric screenings. 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. If you are rendering services as part of a facility (i.e., intensive outpatient program . means youve safely connected to the .gov website. The .gov means its official. When a customer receives virtual care services from their regular doctor (or any other provider) as part of this policy and when the provider bills with POS 02 customers with certain benefit plans may have a lower cost-share. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance. If a provider typically delivered face-to-face services in a facility setting, that provider could also deliver any appropriate service virtually consistent with existing Cigna policies through December 31, 2020 dates of service. For dates of service February 4, 2020 through February 15, 2021, Cigna covered COVID-19 treatments without customer cost-share. Previously, these codes were reimbursable as part of our interim COVID-19 accommodations. Yes. Store and forward communications (e.g., email or fax communications) are not reimbursable. website belongs to an official government organization in the United States. or As of April 1, 2021, Cigna resumed standard authorization requirements. No. Through December 31, 2020 dates of service, providers could deliver virtual neuropsychological and psychological testing services and bill their regular face-to-face CPT codes that were on their fee schedule . We are awaiting further billing instructions for providers, as applicable, from CMS. Urgent care centers will not be reimbursed separately when they bill for multiple services. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. PT/OT/ST providers should continue to submit virtual claims with a GQ, GT, or 95 modifier and POS 02, and they will be reimbursed at their face-to-face rates. 1 In an emergency, always dial 911 or visit the nearest hospital. that insure or administer group HMO, dental HMO, and other products or services in your state). Here is a complete list of place of service codes: Place of Service Codes. Please know that we 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. 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. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; Services not related to COVID-19 will have standard customer cost-share. Check with individual payers (e.g., Medicare, Medicaid, other private insurance) for reimbursement policies regarding these codes. Below is a definition of POS 02 and POS 10 for CMS-1500 forms, alongside a list of major insurance brands and their changes. In order to bill these codes, the test must be FDA approved or cleared or have received Emergency Use Authorization (EUA). There may be limited exclusions based on the diagnoses submitted. 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. No. For all other IFP plans outside of Illinois, primary care physicians are still encouraged to coordinate care and assist in locating in-network specialists, but the plans no longer have referral requirements as of January 1, 2021. 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. Cigna Telehealth Place of Service Code: 02. Cost share is waived for all covered eConsults through December 31, 2021. Telephone codes were added to the list of services that can be billed via telehealth, and the rates for codes 99441-99443 were increased, to match the rates for 99212-99214 Office visit codes must still use two-way audio and visual, real time interactive technologies, but the payment rates for audio only codes (99441-99443) were increased ** The Benefits of Virtual Care No waiting rooms. You can decide how often to receive updates. Diagnostic tests, which indicate if the individual carries the virus and can infect others, Serology (i.e., antibody) tests, which indicate if the individual had a previous infection and has now potentially developed an immune response, An individual seeks and receives a COVID-19 diagnostic test from a licensed or authorized health care provider; or, A licensed or authorized health care provider refers an individual for a COVID-19 diagnostic test; and, The laboratory test is FDA approved or cleared or has received Emergency Use Authorization (EUA); and, The test is run in a laboratory, office, urgent care center, emergency room, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU; and, The results of a molecular or antigen test are non-diagnostic for COVID-19 and the results of the antibody test will be used to aid in the diagnosis of a condition related to COVID-19 antibodies (e.g., Multisystem Inflammatory Syndrome); and. 3. Cost-share will be waived for COVID-19 related services only when providers bill the appropriate ICD-10 code and modifier CS. Treatment plans will be completed within a maximum of 3 business days, but usually within 24 hours. The Consolidated Appropriations Act of 2023 extended many of the telehealth flexibilities authorized during the COVID-19 public health emergency through December 31, 2024. Please review the Virtual care services frequently asked questions section on this page for more information. Modifier 95, GT, or GQ must be appended to the appropriate CPT or HCPCS procedure code(s) to indicate the service was for virtual care. No. Organizations that offer Administrative Services Only (ASO) plans will be opted in to waiving cost-share for this service as well. No additional credentialing or notification to Cigna is required. Place of Service 02 will reimburse at traditional telehealth rates. A serology test is a blood test that measures antibodies. As a reminder, standard customer cost-share applies for non-COVID-19 related services. Talk privately with a licensed therapist or psychiatrist by appointment using your phone, tablet, or computer. Insurance Reimbursement Rates for Psychotherapy, Insurance Reimbursement Rates for Psychiatrists, Beginners Guide To Mental Health Billing, https://cignaforhcp.cigna.com/public/content/pdf/resourceLibrary/behavioral/attestedSpecialtyForm.pdf, guide on HIPAA compliant video technology for telehealth, https://www.cigna.com/hcpemails/telehealth/telehealth-flyer.pdf, Inquire about our mental health insurance billing service, offload your mental health insurance billing, We charge a percentage of the allowed amount per paid claim (only paid claims). Place of Service 02 in Field 24-B (see sample claim form below) For illustrative purposes only. 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). 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. A facility which primarily provides health-related care and services above the level of custodial care to individuals but does not provide the level of care or treatment available in a hospital or SNF. COVID-19 admissions would be emergent admissions and do not require prior authorizations. 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. When billing, you must use the most appropriate code as of the effective date of the submission. 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. A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. Contracted providers cannot balance bill customers for non-reimbursable codes. In these cases, the provider should bill as normal on a UB-04 claim form with the appropriate revenue code and procedure code, and also append the GQ, GT, or 95 modifier. all continue to be appropriate to use at this time. 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.