We have given you an image of the CMS webpage, but encourage you to visit the CMS website directly for more information. Important notes, What the accepting facility should know and do. This code will only be covered where state mandates require it. 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. 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. Please review the Virtual care services frequently asked questions section on this page for more information. 3. 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. The codes may only be billed once in a seven day time period. One of our key goals is to help customers connect to affordable, predictable, and convenient care anytime, anywhere. Cost-share is waived only when billed by a provider or facility without any other codes. Yes. When billing for the service, indicate the place of service as where the visit would have occurred if in person. Please note that we continue to request that providers do not bill with modifiers 93 or FQ at this time. A serology test is a blood test that measures antibodies. Urgent care centers will not be reimbursed separately when they bill for multiple services. Similar to other providers and facilities, urgent care centers should bill just the appropriate COVID-19 vaccine administration code when that is the only service they are providing.Consistent with our reimbursement strategy for all other providers, urgent care centers will be reimbursed for covered vaccine administration services at contracted rates when specific contracted rates are in place for vaccine administration codes. Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. 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. When an order for home health services is clinically appropriate for telehealth services, the care will be offered through a virtual visit unless the order indicates that home health services must be in-person or the patient refuses the virtual visit. 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. UnitedHealthcare (UHC) is now requiring physicians to bill eligible telehealth services with place of service (POS) 02 for commercial products. 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. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. https:// Cigna covers FDA EUA-approved laboratory tests. Reimbursement will be consistent as though they performed the service in a face-to-face setting. This includes when done by any provider at any site, including an emergency room, free-standing emergency room, urgent care center, other outpatient setting, physicians office, etc. Please note that this list is not all inclusive and may not represent an exact indication match. on the guidance repository, except to establish historical facts. Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning. For additional information about our coverage of the COVID-19 vaccine, please review our. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit. These codes are used to report episodes of patient care initiated by an established patient or guardian of an established patient. Yes. Yes. This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan. Providers can call Cigna customer service at 1.800.88Cigna (882.4462) to check a patients eligibility information, including if their plan offers coverage for these purposes. Yes. No. However, we believe that FDA and EUA-approved vaccines are safe and effective, and encourage our customers to get vaccinated. Please review these changes by going to the Provider FastFax page and selecting fax number 30. All health insurance policies and health benefit plans contain exclusions and limitations. Refer to the Telemedicine Website for a list of billing codes which may be used with Place of Service (POS) 02 or 10. Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication). A federal government website managed by the 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. Is there a code that we can use to bill for this other than 99441-99443? Please review the "Virtual care services" frequently asked questions section on this page for more information. 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. identify telehealth or telephone (audio only) services that were historically performed in the office or other in person setting (E.g. ICD-10 code U07.1, J12.82, M35.81, or M35.89. . 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. No additional modifiers are necessary to include on the claim. 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. A facility that provides comprehensive rehabilitation services under the supervision of a physician to outpatients with physical disabilities. Learn how to offload your mental health insurance billing to professionals, so you can do what you do best. Cigna will cover Evusheld when administered for the prevention of COVID-19 in certain adults and pediatric individuals consistent with FDA EUA guidance and Cigna's Drug and Biologics Coverage Policy, effective with dates of service on and after December 8, 2021.Please note that Cigna does not require prior authorization for the use or administration of Evusheld. Providers administering the vaccine to individuals without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the Provider Relief Fund. A location which provides treatment for substance (alcohol and drug) abuse on an ambulatory basis. All Time (0 Recipes) Past 24 Hours Past Week Past month. Cigna will not make any limitation as to the place of service where an eConsult can be used. When specific contracted rates are in place for diagnostic COVID-19 tests, Cigna will reimburse covered services at those contracted rates. What place of service code should be used for telemedicine services? Yes. A certified facility which is located in a rural medically underserved area that provides ambulatory primary medical care under the general direction of a physician. When the tests are performed for general population or public health surveillance, for employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19, Cigna will generally not cover in-vitro molecular, antigen, or antibody tests for asymptomatic individuals. 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. For example, an infectious disease specialist could provide a virtual consultation for an ICU patient, document the level of care provided, bill the appropriate face-to-face E&M code with modifier GQ, GT, or 95, and be reimbursed at the face-to-face rate. Prior authorization for treatment follows the same protocol as any other illness based on place of service and according to plan coverage. NOTE: As of March 2020, Cigna has waived their attestation requirements however we always recommend calling Cigna or any insurance company to complete an eligibility and benefits verification to ensure your telehealth claims will process through to completion. We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. For dates of service April 1 - June 30, 2022, Cigna will apply a 1% payment adjustment. Customer cost-share will be waived for COVID-19 related virtual care services through at least. Under normal circumstances, the provider would bill with the Place of Service code 2, to indicate the care was rendered via telehealth. Providers will not need a specific consent from patients to conduct eConsults. They have a valid license and are providing services within the scope of their license; If the customer has out-of-network benefits. 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. The location where health services and health related services are provided or received, through telecommunication technology. 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.