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. What CPT, HCPCS, ICD-10 and other codes should I be aware of related to COVID-19? 31, 2022. 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 admitted as inpatients or outpatients. The interim COVID-19 virtual care guidelines as outlined on this page were in place for dates of service through December 31, 2020. Selecting these links will take you away from Cigna.com to another website, which may be a non-Cigna website. Inpatient COVID-19 care that began on or before February 15, 2021, and continued on or after February 16, 2021 at the same facility, will have cost-share waived for the entire course of the facility stay. Please note that our interim COVID-19 virtual care guidelines were in place until December 31, 2020. 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. The change in the telehealth policy will take effect on January 1, 2022, and be implemented on April 4, 2022. When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. One of our key goals is to help your patients connect to affordable, predictable, and convenient care anytime, anywhere. Comprehensive Inpatient Rehabilitation Facility. Additional information about the COVID-19 vaccines, including planning for a vaccine, vaccine development, getting vaccinated, and vaccine safety can be found on the CDC website. Routine and non-emergent transfers to a secondary facility continue to require authorization. CPT 99490 covers at least 20 minutes of non-face-to-face chronic care management services provided by clinical staff. Most mental health providers will be furnishing services using Place of Service code 10 (POS 10) when providing telehealth services. New and revised codes are added to the CPBs as they are updated. As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement. Effective January 1, 2022, eConsults remain covered, but cost-share applies for all covered services. Sign up to get the latest information about your choice of CMS topics. Specialist to specialist (e.g., ophthalmologist requesting consultation from a retina specialist, orthopedic surgeon requesting consultation from an orthopedic surgeon oncologist, cardiologist with an electrophysiology cardiologist, and obstetrician from a maternal fetal medicine specialist), Hospitalist requests an infectious disease consultation for pulmonary infections to guide antibiotic therapy, The ICD-10 code that represents the primary condition, symptom, or diagnosis as the purpose of the consult; and. Yes. lock Telehealth services not billed with 02 will be denied by the payer. Please note that this guidance applies to drive through testing as well, and includes services performed by a free-standing emergency room or any other provider. Services include individual and group therapy and counseling, family counseling, laboratory tests, drugs and supplies, psychological testing, and room and board. To receive payment equivalent to a normal face-to-face visit you will not bill POS 2 and instead will follow Medicare guidance to bill POS 11 as if care was delivered in the office during COVID-19. Denny and his team are responsive, incredibly easy to work with, and know their stuff. ), 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. When the condition being billed is a post-COVID condition, please submit using ICD-10 code U09.9 and code first the specific condition related to COVID-19. 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. Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004. As a reminder, standard customer cost-share applies for non-COVID-19 related services. 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. Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share. Contracted providers cannot balance bill customers for non-reimbursable codes. For all Optum Behavioral Health commercial plans, any telehealth services provided via a real-time audio and video communication system can be billed for members at home or another location. 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. Additionally, for any such professional claim providers must include: modifier 95 to indicate services rendered via audio-video telehealth; Throughout the pandemic, the emergency use authorized monoclonal antibody drug bebtelovimab was purchased by the federal government and offered to providers for free. 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. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. This will help ensure Cigna properly waives cost-share for appropriate COVID-19 related care. Clarifying Codes G0463 and Q3014: Hospital Billing for - Vitalware For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth. Visit CignaforHCP.com/virtualcare for information about our new Virtual Care Reimbursement Policy, effective January 1, 2021. 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. 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). The cost-share waiver for COVID-19 related treatment ended with February 15, 2021 dates of service. Our mental health insurance billing staff is on call Monday Friday, 8am-6pm to ensure your claims are submitted and checked up on with immediacy. Neither U0003 nor U0004 should be used for tests that are used to detect COVID-19 antibodies. The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. 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. Services include physical therapy, occupational therapy, speech pathology, social or psychological services, and orthotics and prosthetics services. In addition, it's my interpretation that Cigna is only paying for telehealth services for physical, occupational and speech therapy submitted on a 1500-claim form by a private practice. UPDATED 5/20/20: Telehealth Billing & Coding During COVID-19 That is why in 2015, CMS began reimbursing providers for a program called non-complex Chronic Care Management (CCM), billed as the new code CPT 99490. Cigna will not make any limitation as to the place of service where an eConsult can be used. Non-residential Substance Abuse Treatment Facility, Non-residential Opioid Treatment Facility, A location that provides treatment for opioid use disorder on an ambulatory basis. (Description change effective January 1, 2022, and applicable for Medicare April 1, 2022.). Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification. ICD-10 diagnosis codes that generally reflect non-covered services are as follows. No. 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. Treatment is supportive only and focused on symptom relief. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. 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. *Please Note: virtual check-in and E-visit codes must be billed with Place of Service (POS) 02 and modifier GT. This will allow for quick telephonic consultations related to COVID-19 screening or other necessary consults, and will offer appropriate reimbursement to providers for this amount of time. Talk to board-certified dermatologists without an appointment for customized care for skin, hair, and nail conditions. Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans.