CIGNA Will Cover Well Visits (and more) via telemedicine

We’re monitoring claims at PCC and it looks like CIGNA is paying for well visits via telemedicine. Here’s their official position on it.

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

Q: What services can providers deliver virtually and what will they get reimbursed?

Any service that is currently on a provider’s fee schedule can be provided virtually.* This means that if a provider has a code on their fee schedule today that is reimbursable, they can offer that same service virtually and bill us using the same code (plus the GQ, GT, or 95 modifier), and be reimbursed the full face-to-face amount, at least until May 31, 2020. We will closely monitor and audit claims for inappropriate services that cannot be performed virtually (e.g., surgical codes).

  • Please note that PT/OT/ST providers have separate guidance.

That is consistent with what we have seen with our early claims. It is not, however, paid with parity.

Including CIGNA? Because they say right there that it will be paid at the full face-to-face amount. Our claim sample says they’re being paid fully.

When the smoke settles on all this, I’m all for publicly shaming all the inscos who cut payments on E&Ms for telemedicine. Talk about profiteering.

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Cigna is paying our well visits at parity from what I have seen so far

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IF Cigna is indeed paying well visits by TH at parity, can we assume (lol) that when we bring the patient back (which we will) for hearing/vision/bloodwork/vaccines that we can bill that as a standalone and get paid?

I wouldn’t assume anything, of course, but I believe guidance is in the works
to permit this very process. A telemedicine delivered 9939X with perhaps a
96110 or 96127. Later, at the earliest opportunity, shots/vision/etc., get
delivered with no additional E&M.

One of the tricks will be to do that work at requested sick visits and get paid.

It’s sad that it’s so OBVIOUS what needs to be done but we have to FIGHT for
it the entire way.

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thanks Chip- it is so obvious that all we are doing is trying to take care of kids the best way we can and to have to fight this at every step makes everything so much harder.

I’d be curious to know if you resubmitted it and the made up the parity.

Are the lobbyists on that?

Yes, very very much.

We have resubmitted our underpaid claims and they will be made whole per billing. Tip for others out there (both sick and well telehealth codes)

Be aware that Cigna cannot dictate what the ERISA plans do. You may have some “Cigna” administered plans which do not pay. From my rep today:

"The treatments that Cigna will cover for COVID-19 are those covered under Medicare or other applicable state regulations. We will reimburse health care providers at Cigna’s in-network rates or Medicare rates, as applicable. 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 to 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.*