Cigna Announces 2021 Virtual Care Reimbursement Policy
Cigna has announced their Virtual Care Reimbursement Policy for calendar year 2021. This announcement only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). Cigna Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans.
In this article, I will answer the following questions:
- What practice setting(s) does this policy apply to?
- What Place of Service (POS) code do I use on the claim form?
- What CPT codes can be reimbursed if provided via telehealth (virtual care)?
- What modifier(s) must be appended to the CPT codes on the claim form?
- Must I use both audio and video technology when performing a telehealth visit?
- What resources does Cigna provide regarding their new Virtual Care Reimbursement Policy?
What practice setting(s) does this policy apply to?
What Place of Service (POS) code do I use on the claim form?
Beginning with dates of service on and after January 1, 2021, will Cigna pay for outpatient therapy services delivered via telehealth for providers who submit claims on a UB-04 claim form?
Answer: Updated January 4, 2021
What modifier(s) must be appended to the CPT codes on the claim form?
Must I use both audio and video technology when performing a telehealth visit?
What resources does Cigna provide regarding their new Virtual Care Reimbursement Policy?
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In many places Cigna has contracted with American Specialty Health to administrate the physical therapy benefits. Do you know if ASH is going to provide the same benefit or does this information just apply when claims go directly to Cigna?
ASH is not the insurance carrier. They just administer the therapy benefits per the Cigna policies. If you have concerns, I would recommend you contact Cigna and ask them.
Has there been an guidance or insight on billing on the UB04 for telehealth?
At this time, in 2021, it’s only for providers who submit claims on a 1500-claim form.
Hi – the below is from Cigna’s FAQ on virtual care:
Can providers who typically deliver services in a facility setting perform virtual services on and after January 1, 2021?
Yes. While the virtual care policy going into effect on January 1, 2021 only applies to CMS-1500 claims, we will continue to reimburse virtual care services billed on a UB-04 claim form through the COVID-19 public health emergency (PHE) period when the services:
It appears as if UB-04 is still possible through the PHE.
Please let me know if I am reading this incorrectly.
Yes! I wrote the article prior to them updating the FAQ section. Thank you!
hi Rick- the links to the Cigna policies are broken- all going to 404 Not Found. I’m sure it’s a challenge to keep those up! Thanks
It is something with Cigna as even on Cigna’s site, their links to their Virtual Care Policy do not work.