Information At Your Fingertips
Keeping You Informed
Given today’s environment I wanted to share Cigna’s capabilities and services to support Cigna customers during these trying times..
Did you know our customer service line has been open 24-7-365 over 5 years now? I have included our flyer.
Also attached is a brochure on Cigna’s telehealth services which thru both MDLive and Amwell for Cigna, provides Cigna customers with convenient access for treatment of minor conditions. These services have been available for about two years. The Cigna member is charged their PCP copay.
We expect a rising trend in virtual care therefore Cigna is updating its provider contracts to cover virtual care provided by existing Cigna contracted providers that are not part of our two telemedicine programs. Specific guidelines are pasted below however we expect it to be modified as this is a fluid topic. The goal is to permanently embrace these services going forward with our contacted providers.
As recently communicated All COVID-19 related services are covered without member cost share. Contracted providers already have communications and procedures in place for this pandemic. Below are some FAQ and provider guidance on virtual services outside our telemedicine program. Thank you
COVID-19 VIRTUAL CARE
Q: Will Cigna allow in-network providers to provide virtual care?
Yes. We are making it easier for customers to be treated virtually by their physicians who have the ability to offer virtual care. All providers can deliver virtual care to Cigna customers when the services are billed consistently with the guidance. We are implementing this enhanced measure through May 31, 2020 to protect our customers by mitigating exposure risks and alleviating transportation barriers.
We are also working on a permanent Virtual Care Reimbursement Policy that will continue to allow providers in our network to offer virtual care after June 1, 2020. More information about this policy will be shared with providers in the coming months. In the meantime, our COVID-19 virtual care guidance will remain in effect until at least May 31, 2020.
Q: How will Cigna cover virtual care for COVID-19 related services?
When providers follow the billing guidance, we will cover virtual care as follows:
• For COVID-19 related screening (i.e., quick phone or video consult): o By contracted physician in Cigna's network: No cost-share for customer
o By virtual vendor (e.g., Amwell or MDLive): No cost-share for customer
• For non-COVID-19 related services (e.g., oncology visit, routine follow-up care) o By contracted physician in Cigna's network: Reimbursable at standard office visit rates.
o By virtual vendor (e.g., Amwell or MDLive): Reimbursable at standard rates currently in place today.
Q: How is Cigna complying with state mandates related to COVID-19, such as customer cost share, virtual care policies, testing covered at 100%?
Cigna health plans comply with all state mandates as applicable. We are actively reviewing all COVID-19 state mandates and will continue to share more details around coverage, reimbursement, and cost-share as it is available.
GUIDANCE- All other virtual visits:
a. CPT® code 99241 will be reimbursed for all other synchronous real-time virtual visits when billed with Place of Service 11.
b. If the visit is related to COVID-19, the above-mentioned ICD10 diagnosis codes (Z03.818 or Z20.828) are required to be billed and reimbursement will be without customer copay/cost-share.
c. 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.
d. No virtual care modifier should be billed
e. This billing requirement and associated reimbursement applies to services submitted on CMS1500 claim forms or its electronic equivalent only.
Office consultation for a new or established patient, which requires these 3 key components: a problem focused history; a problem focused examination; and straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care providers, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family
Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care provider who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
We are in this together. Thank you!