Q: Can providers offer quick phone consults for their ...



Cigna's response to COVID-19Cigna Coronavirus (COVID-19) Interim Billing Guidance for Providers for Commercial CustomersUpdated?October 30, 2020?-?Highlighted text indicates updatesAs the COVID-19 pandemic continues, we appreciate that providers across the country are on the front line to offer dedicated care to our customers and help protect local communities.As federal guidelines continue to evolve in support of the COVID-19 pandemic, we have again extended our interim coverage accommodations for commercial Cigna medical services, as follows:The?cost-share waiver for COVID-19 diagnostic testing and related office visits is extended until January 21, 2021.The?cost-share waiver for COVID-19 related treatment is extended until December 31, 2020.Some?other interim accommodations (e.g., for credentialing and authorizations) are extended through December 31, 2020, as outlined on this page.The?interim COVID-19 virtual care guidelines as outlined on this page are in place until December 31, 2020. Beginning January 1, 2021, we will implement a new Virtual Care Reimbursement Policy. Please visit?virtualcare?for additional information about this new policy.The following COVID-19 billing and reimbursement guidelines for commercial Cigna medical services* are designed to make it as easy as possible for you to continue to focus on delivering quality, safe, and efficient care to your patients.General Virtual Care GuidelinesIn an effort to make it as easy as possible for our customers to access timely and safe care, while ensuring that providers can continue to deliver necessary services in safe settings, Cigna will allow 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.This means that providers can perform services for commercial Cigna medical customers in a virtual setting and bill as though the services were performed face-to-face.Providers should bill using a face-to-face code, append the GQ, GT or 95 modifier, and use the POS that would be typically billed if the service was delivered face to face (e.g., POS 11).Providers will be reimbursed consistent with their typical face-to-face rates.Providers can also bill code G2012 for a 5-10 minute phone conversation, and Cigna will waive cost-share for customers until?January 21, 2021. 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.Customer cost-share will be waived for COVID-19 related virtual services through?January 21, 2021.Please review the “Virtual care services” frequently asked questions section below for additional information about our interim COVID-19 virtual care guidelines.Effective January 1, 2021, we will implement a new?Virtual Care Reimbursement Policy. Please visit?virtualcare?for additional information about that policy.General billing guidance for COVID-19 related servicesServiceCode(s) to billCommentsVirtual screening telephone consult (5-10 minutes)G2012Must be performed by a licensed providerCovered with no cost-share until?January 21, 2021Virtual or face-to-face visit for screening for?suspected?or?likely?COVID-19 exposureUsual face-to-face E/M codeICD10 code Z03.818 or Z20.828Modifier CSAppend with GQ, GT or 95 modifier for virtual careCost-share is waived through?January 21, 2021Cost-share will be waived for COVID-19 related services only when providers bill the appropriate ICD-10 code and modifier CSModifier CR or condition code DR can also be billed instead of CSServices not related to COVID-19 will have standard customer cost-shareVirtual or face-to-face visit for treatment of a?confirmed?COVID-19 caseUsual face-to-face E/M codeICD10 code U07.1Append with GQ, GT or 95 modifier for virtual careCost-share is waived through?December 31, 2020Cost-share will be waived only when providers bill the appropriate ICD-10 code (U07.1)Note that billing B97.29 will not waive cost-share. As of August 1, 2020, U07.1 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnosesCigna will reimburse at usual face-to-face ratesEffective for dates of service on and after February 4, 2020COVID-19 laboratory testing (including PCR, antigen, and serology [i.e., antibody] tests)PCR and antigen tests: U0001, U0002, U0003, U0004, 87426, 87635,?87636,?87637,?87811, 0202U, 0223U, 0225U,?0240U, and?0241UAntibody tests: 86328, 86769, 86408, 86409,?86413, and 0224USee updated?COVID-19: In Vitro Diagnostic Testing coverage policy?for additional coverage detailsCigna covers medically necessary diagnostic molecular and antigen tests for COVID-19 through?January 21, 2021?without cost-shareCost-share is waived only when providers bill one of the identified codesIn order to bill these codes, the test must be developed and administered in accordance with the specifications outlined by the FDA Emergency Use Authorization (EUA) or through state regulatory approvalCigna may request the appropriate CLIA-certification or waiver as well as the manufacturer and name of the test being performedWhen covered, Cigna will reimburse at 100% of MedicareEffective November 1, 2020, Z11.59 (asymptomatic screening) will not be covered when billed alone. It may be covered when it is billed with a diagnosis code that reflects active signs and or symptoms of infection or disease. Other appropriate codes for asymptomatic testing are considered for coverage, including Z03.818 and Z20.828, when used to reflect medically necessary coverage, as described in our updated?COVID-19: In Vitro Diagnostic Testing coverage policyCigna only covers diagnostic serology tests when medically necessary (e.g., for an individual 21 years old or younger when used to aid in the diagnostic assessment of MIS-C)Specimen collectionC9803, G2023, and G2024Cost-share is waived through?January 21, 2021Cost-share is waived only when billed by a provider or facility without any other codesWhen covered, reimbursement is at 100% of MedicareSpecimen?collection is not 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 any provider, including laboratoriesCOVID-19 related diagnostic tests (other than COVID-19 test)Usual codesICD-10 code Z03.818 or Z20.828Modifier CSFor other laboratory tests when COVID-19 may be suspectedIf the?individual COVID-19 related diagnostic test(s) are included in a laboratory panel code, only the code for the panel test will be reimbursedCost-share is waived through?January 21, 2021?only when providers bill the appropriate ICD-10 code and modifier CSModifier CR and condition code DR can also be billed instead of CSPaid per contractGeneral billing guidance for?non-COVID-19 related servicesServiceCode(s) to billCommentsVirtual screening telephone consult (5-10 minutes)G2012Covered with no cost-share until?January 21, 2021Must be performed by a licensed providerNon COVID-19 virtual visit (i.e., telehealth)Usual face-to-face E/M codeAppend with GQ, GT, or 95 modifierPOS for face-to-face service normally billed (e.g., POS 11)See important notes belowException during public health emergencyCigna will reimburse usual face-to-face ratesServices can be performed by phone, video, or bothStandard cost-share will applyInterim guidelines apply until December 31, 2020Effective January 1, 2021, we will implement a new Virtual Care Reimbursement Policy. Please visit?virtualcare?for additional information about that policy.Non-COVID-19 laboratory testsUsual laboratory codesPaid per contract; standard cost-share appliesIn-office or facility visit not related to COVID-19Usual face-to-face codesStandard cost-share appliesFREQUENTLY ASKED QUESTIONQ: How does Cigna cover COVID-related virtual care services?Cigna will cover virtual care by a provider or virtual vendor (e.g., MDLive), as follows:For COVID-19 related screening (i.e., quick phone or video consult): No cost-share for customer through?January 21, 2021For non-COVID-19 related services (e.g., oncology visit, routine follow-up care): Standard customer cost-shareQ: Does?Cigna cover code Q3014 to reimburse a telehealth originating site or facility fee?No. Cigna does not reimburse an originating site of service fee or facility fee for telehealth visits, including for code Q3014, as they are not a covered benefit. This code will only be covered where state mandates require it.Q: Can providers offer quick phone consults for their patients related to COVID-19 or other necessary services?Yes. Providers can bill code G2012 for a quick 5-10 minute phone conversation through?January 21, 2021, with cost-share waived for customers. 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.Q: Does Cigna allow urgent care centers to provide virtual care?Yes. Cigna reimburses urgent care centers for delivering virtual care through?January 21, 2021.Urgent care centers can also bill code G2012 through?January 21, 2021?for a quick 5-10 minute phone consultation. Reimbursement is capped at $50 for these services.Urgent care centers can also bill their typical S9083 code for services that are more complex than a quick telephone call. In these cases, the urgent care center should append a GQ, GT, or 95 modifier, and Cigna will reimburse the full face-to-face rate for insured and Non-ERISA ASO customers in states where telehealth parity laws exist. For all other customers, Cigna will reimburse urgent care centers a flat rate of $88 per virtual visit.Routine care will be subject to cost-share. COVID-19 related care will be reimbursed with no cost-share.Q: Does Cigna allow eConsults for COVID-19 and non-COVID-19 related consults?Yes. Effective for dates of service on and after March 2, 2020 until?January 21, 2021, Cigna will allow eConsults when billed with codes 99446-99449, 99451, and 99452 for all conditions.Q. Does Cigna cover diagnostic laboratory tests for COVID-19?Yes. To help remove any barriers to receive testing, Cigna will cover any medically necessary diagnostic molecular or antigen diagnostic test for COVID-19, including rapid tests and saliva-based tests, through?January 21, 2021?without cost-share when:The test is recommended by a health care provider;A diagnosis of COVID-19 is being considered and the tests are used as part of an evaluation;The laboratory test is developed and administered in accordance with the instructions for use (IFU) document outlined by the FDA Emergency Use Authorization (EUA) or through State regulatory approval;The test is run in a laboratory or office with the appropriate CLIA certification (or waiver), as described in the EUA IFU. Please note that high-throughput tests may only be run in a high-complexity laboratory; andThe laboratory or provider bills using the codes in our interim billing guidelines and?testing coverage policy.This applies to customers enrolled in Cigna's employer-sponsored plans in the United States, Medicare Advantage, Medicaid, and the Individual & Family plans available through the Affordable Care Act. Organizations that offer Administrative Services Only (ASO) plans will be opted in to waiving cost-share for this service as well.Important notes:Cigna does not cover code 0226U, as it is considered not medically necessary.Tests may not be covered in certain circumstances, including for back-to-work and back-to-school purposes, and when the tests are not diagnostic or medically necessary (e.g., serology tests for non-diagnostic reasons). Please review these FAQs and?testing coverage policy?for additional information.Cigna follows CMS rules related to the use of modifiers.For additional information about Cigna's coverage of medically necessary diagnostic COVID-19 tests, please review our recently updated?COVID-19 In Vitro Diagnostic Testing coverage policy?(effective August 1, 2020).Q: Does Cigna cover at-home testing kits?Yes. Cigna covers at-home specimen collection testing kits and self-directed serology tests without customer cost-share through?January 21, 2021?when:The test is recommended by a health care provider;The test is developed and administered in accordance with the specifications outlined by FDA Emergency Use Authorization (EUA) or through State regulatory approval; andBilled by a laboratory consistent with our existing interim billing guidelines and?testing coverage policy.Customers are encouraged to give their insurance information to the laboratory where they received the testing (e.g., LabCorp, Quest, Everlywell, etc.) so the laboratory can bill Cigna per standard procedures. However, when customers self-pay for approved at-home testing kits, they can submit claims to Cigna for reimbursement following existing processes.Please note that tests where the specimen is collected and processed in a home environment are not covered.Q: Does Cigna cover COVID-19 laboratory testing codes U0003 and U0004?Yes. Cigna covers FDA EUA-approved laboratory tests. For dates of service April 14, 2020 until at least?January 21, 2021, Cigna will cover U0003 and U0004 with no customer cost-share when billed by laboratories using high-throughput technologies as described by?CMS.Q: Does Cigna cover COVID-19 diagnostic laboratory tests performed by urgent care centers?Yes. Cigna covers COVID-19 diagnostic laboratory testing without customer cost-share through?January 21, 2021, and will reimburse urgent care centers for these services when:The test is recommended by a health care provider;A diagnosis of COVID-19 is being considered and the tests are used as part of an evaluation;The laboratory test is developed and administered in accordance with the instructions for use (IFU) document outlined by the FDA Emergency Use Authorization (EUA) or through State regulatory approval; andThe test is run in a laboratory or urgent care center with the appropriate CLIA certification (or wavier), as described in the EUA IFU. High-throughput tests may only be run in a high-complexity laboratory.The test is billed consistently with our existing interim billing guidelines and?testing coverage policyPlease note that Cigna may request the appropriate CLIA certification or waiver documentation as well as the manufacturer and name of the test being performed, in order to confirm its EUA status and that the test is being utilized in accordance with the relevant IFU.Q: Does Cigna cover specimen collection codes G2023 and G2024?Yes. These codes will be covered with no customer cost-share through?January 21, 2021?when billed by a provider or facility.Cigna will reimburse providers consistent with CMS rates, as follows:G2023: $23.46G2024: $25.46Q: Who can bill these codes?Cigna will allow reimbursement for these codes by any provider or facility only when billed without any other codes (except where the contract allows it). Specimen collection is not 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 any provider, including laboratories.Q: Does Cigna cover specimen collection code C9803?Yes. Cigna covers C9803 with no customer cost-share for a hospital outpatient clinic visit specimen collection through?January 21, 2021?only when billed without any other codes. 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).Cigna will reimburse this code at $22.99 consistent with?CMS pricing, and reimbursement will only be provided for hospital outpatient services performed in a clinic setting when billed on a UB-04 claim form with an appropriate revenue code.Cigna is reimbursing this amount consistent with CMS during this public health emergency to ensure consistent, timely, and reasonable reimbursement.Q: Does Cigna cover serology tests?Effective August 1, 2020, Cigna covers diagnostic serology (i.e., antibody) tests without cost-share when medically necessary (e.g., for a symptomatic individual 21 years old or younger to aid in the diagnosis of suspected multisystem inflammatory syndrome in children [MIS-C]). When used for medically necessary, diagnostic purposes, Cigna will cover FDA EUA approved COVID-19 serology tests without cost-share through?January 21, 2021?when billed with the appropriate CPT codes.Please note that Cigna does not cover serology tests when used for non-diagnostic or non-medically necessary purposes (e.g., for surveillance or return-to-work).Q: Will Cigna waive customer co-pay and cost-sharing requirements for services related to COVID-19 physician visits?Yes. Cigna will waive all customer co-pay and cost-share for screening, testing, and treatment related to COVID-19, as follows:ServiceCost-share waived throughThe initial COVID-19 screening (virtually, in an office, or at an emergency room, urgent care center, “drive thru” specimen collection center, or other facility)January 21, 2021Specimen collection by a health care providerLaboratory test (performed by state, hospital, or commercial laboratory; or other provider)Treatment (treatments that Cigna will cover for COVID-19 are those covered under Medicare or other applicable state regulations. Additional information related to treatments will be shared soon.)December 31, 2020The visit will be covered without customer cost-share if the provider determines that the visit was consistent with COVID-19 screening and evaluation purposes. The provider will need to code appropriately to indicate COVID-19 related services.Please note that while Cigna Medicare customers also have cost-share waived for certain non-COVID-19 related virtual and in-person office exams and consultative services through the end of the year, cost-share still applies for Cigna commercial customers?(including Cigna IFP customers as of November 1, 2020)?for these non-COVID-19 related services.Q: Will Cigna waive customer cost-share for treatment of COVID-19?Yes. For dates of service February 4, 2020 through?December 31, 2020, Cigna will cover COVID-19 treatments without customer cost-share. This policy applies 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). 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.Q: What treatments will Cigna cover with no cost-share?Cigna will waive cost-share for COVID-19 related treatment, in both inpatient and outpatient settings, through?December 31, 2020. There may be limited exclusions based on the diagnoses submitted. Please note that per the preceding question, some opt-outs for self-funded benefit plans may apply.Q: Is Cigna waiving cost-share for all in-network facilities? Does that include rehabilitation centers, skilled nursing facilities, etc.?Yes. Until?December 31, 2020, Cigna will waive customer cost share for any approved COVID-19 treatment, no matter the location of the service. Locations may include hospitals, rehabilitation centers, skilled nursing facilities, temporary hospitals, or any other facility where treatment is generally provided.Q: Is Cigna waiving cost-share for medications related to the treatment of COVID-19?There are currently no outpatient FDA-approved medications for the treatment of COVID19 that meet CMS or state regulations.However, Cigna will waive customer cost-share for any FDA-approved medication or any other FDA-approved treatment for COVID-19 through?December 31, 2020, if and when available.Q: Does?Cigna cover Remdesivir for the treatment of COVID-19?Yes. On October 22, 2020, the FDA?approved?Remdesivir for the treatment of COVID-19 in adults and children 12 years of age and older and weighing 40 kg (~88 lbs.) or more. It is the first and only FDA-approved treatment for COVID-19 and it must be administered in a hospital or in a “healthcare setting capable of providing acute care comparable to inpatient hospital care.” When administered consistent with the FDA approval, Cigna covers Remdesivir for the treatment of COVID-19 with no cost-share to the customer through December 31, 2020.Q: How will providers need to bill for COVID-19 treatment to ensure cost-share is waived?For services provided through?December 31, 2020, providers will need to bill consistent with our interim billing guidelines by including the Diagnosis code (Dx) U07.1 on claims related to the treatment of COVID-19. Please refer to the general billing guidance for additional information.Q: Will providers be reimbursed for the customer cost-share amount that will be waived?Yes. Cigna will reimburse providers the full allowed amount of the claim, including what would have been the customer's cost share.Q: Does Cigna offer additional reimbursement for personal protective equipment (PPE) and supply-related costs?(e.g., CPT code 99072)?for medical providers?No. Cigna does not provide additional reimbursement for PPE-related costs,?including supplies, materials, and additional staff time (e.g., CPT code 99072), as office visit (E&M) codes include overhead expenses, such as necessary PPE. Separate codes providers may use to bill for supplies are generally considered incidental to the overall primary service and are not reimbursed separately. Contracted providers cannot balance bill customers for non-reimbursable codes.Q: Are referral requirements to see other physicians, specialists, or facilities being waived?Yes. Primary care physician referrals for specialist office visits are being waived temporarily through the end of the year for Individual & Family Plans (IFP) and through?February 28, 2021?for SureFit plans. Suspending the referral requirement will allow providers and Clinical Intake teams to better focus on COVID-19 critical care needs during this time. Claims will not be denied due to lack of referral for these services.If a provider calls or faxes in a referral for an IFP or SureFit plan customer, they will receive a message indicating that Cigna is waiving the referral requirement through the specified time period.Please note that HMO and other network referrals are still required, so providers should continue to follow the normal process that is in place today.Q: Is Cigna relaxing credentialing requirements during the COVID-19 pandemic?Yes. Cigna has accelerated its initial credentialing process for COVID-19 related applications. We anticipate that the majority of providers will be initially credentialed through this accelerated credentialing process to address COVID-19 related services. This accelerated initial credentialing process will be available until?December 31, 2020. Providers are asked to identify that their credentialing request is a COVID-19 application upon submission.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.Q: What is Cigna's approach to allow participating providers to deliver in-person or virtual care in a state where they are not licensed or accredited?Cigna will allow commercial and behavioral providers who are participating with Cigna (and who have up-to-date credentialing) to provide in-person or virtual care in other states?through December 31, 2020, to the extent that the scope of the license and state regulations allow such care to take place.Providers can request the additional states to be loaded through the normal credentialing submission process by emailing Cigna at?MedicalOnboarding@. Providers should indicate "COVID-19" in the subject line and attach any applicable documents. The provider will be loaded to the networks in the state(s) as requested and will not need additional credentialing.When a state allows an emergent temporary provider licensure, Cigna will allow providers to practice in that state as participating if a provider is already participating with Cigna, is in "good standing," and if state regulations allow such care to take place. 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 rming Cigna prior to delivering services in other states can help to ensure claims are adjudicated correctly when submitted with addresses in states other than the provider's usual location.Q: Does Cigna cover pre-admission and pre-surgical COVID-19 testing?Yes. Cigna covers pre-admission and pre-surgical COVID-19 testing with no customer cost-share when performed in an outpatient setting until?January 21, 2021. Providers should bill the pre-admission or pre-surgical testing of COVID-19 separately from the surgery itself using ICD-10 code Z01.812 in the primary position.Q: Has Cigna extended the timeframe for prior authorization decisions?Yes. Effective March 25, 2020 through?December 31, 2020, for all requests received for all Cigna lines of business, we are temporarily increasing the authorization window for all elective inpatient and outpatient services from three months to six months. Elective inpatient and outpatient prior authorization decisions made between January 1, 2020 and March 24, 2020 will be assessed when the claim is received and will go payable as long as it is within six months of the original authorization.Q: Has Cigna removed prior authorization requirements for advanced imaging?No. Cigna continues to require prior authorization reviews for routine advanced imaging. Per usual protocol, emergency and inpatient imaging services do not require prior authorization. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. Approximately 98% of reviews are completed within two business days of submission. We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. Please note that Cigna has 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?December 31, 2020.Q: What is Cigna doing to help facilitate prompt transfer of patients from acute inpatient facilities?In order to help facilitate freeing up bed space for COVID-19 patients, Cigna will allow emergent or urgent direct transfers for the expressed purpose of freeing up bed space for COVID-19 acute inpatient admissions to skilled nursing facilities (SNF), acute rehabilitation facilities (AR), and long-term acute care hospitals (LTACH) without prior authorization until?December 31, 2020?for both commercial and Medicare businesses.SNF, AR, and LTACH facilities are responsible for notifying Cigna of admissions the next business day.Coverage reviews for appropriate levels of care and medical necessity still apply to SNF, AR, and LTACH admissions.Concurrent review will start the next business day with no retrospective denials.Per usual policy, Cigna does not require three days of inpatient care prior to transfer to an SNF.Please note that routine and non-emergent transfers to SNF, AR, and LTACH continue to require precertification, and if a hospital is not at capacity and requiring the need to free up bed space for COVID-19, all of these transfers still require precertification. ................
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