Cigna - Covid19

Policy Search
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Cigna’s policy (through May 31, 2020):

  • Customers can receive non-COVID-19 related virtual care from their provider, covered and reimbursed at standard office visit rates and customer cost-share.
  • Non COVID-19 related in-office and virtual care remains at standard cost share, billing, and reimbursement requirements.

Cigna will reimburse in-person visits, phone calls, real-time synchronous virtual visits, and testing for COVID-19 without copay or cost-share for all individuals covered under a fully-insured Cigna medical benefit plan and when billed according to the following guidelines:

Phone calls for COVID-19 (e.g.: 5-10 min virtual visit with or without video with the licensed health care provider):

  • HCPCS code G2012 will be reimbursed without customer copay or cost-share.

All other virtual visits

  • ONLY CPT® code 99241 will be reimbursed, for all other synchronous real-time virtual visits when billed with Place of Service 11.
  • If the visit is related to COVID-19, ICD10 diagnosis codes (Z03.818 or Z20.828) are required to be billed and reimbursement will be without customer copay/cost-share.
  • If the virtual visit is not related to COVID-19, the ICD10 code for the visit should be billed and reimbursement will be made according to applicable benefits and related cost share.
  • No virtual care modifier should be billed

Read more here:
https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html

Behavioral Telehealth interim guidance:

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Cigna paid me for televisit 70% of office visit

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Looking at the information on Cigna provided by The Verden Group above, it does state:

  • Billing a POS 02 or GT/95 modifier for virtual services may result in reduced payment or denied claims due to current system limitations. While we understand CMS guidance is to bill for a POS 02 for virtual care services, billing a typical place of service will ensure providers receive the same reimbursement as they typically get for a face-to-face visit.

In light of this, I would encourage you to reach out to your local contact to find out when the “current system limitations” will be resolved. This is definitely an issue the AAP should be able to take the lead in addressing at the system level…