Effective April 9, 2020, this article is no longer current. Click HERE to read the latest about Cigna and their coverage of outpatient physical, occupational and speech therapy delivered via telehealth.
This article was updated on March 28, 2020 by adding a link to American Specialty Health and updating the place of service code to use on the 1500-claim form. In addition, it’s my interpretation that Cigna is only paying for telehealth services for physical, occupational and speech therapy submitted on a 1500-claim form by a private practice. Institutional providers (i.e. rehab agencies and hospital outpatient departments) should contact Cigna regarding telehealth coverage for physical, occupational and speech therapy services.
Cigna has announced they will cover virtual care for physical, occupational and speech therapy services through May 31, 2020. These services will be reimbursed consistent with the standard fee schedule.
Physical therapists can use CPT codes 97161, 97162 and 97110. Occupational therapists can use CPT codes 97165, 97166 and 97110. Speech-language pathologists can use CPT codes 92507 and 92526.
If submitting claims on a 1500-claim form, the place of service code would be 11 according to this document from American Specialty Health. On a UB-04 claim form, no place of service code is required. You will also have to append the GQ modifier to each CPT code on the claim form.
Click HERE to access the article and additional billing requirements.
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Thank you for this information. Do you have a contact for Cigna to find out why they did NOT include a Speech eval code?
Thank you, Linda
I do not have a contact for Cigna.
In California, Cigna partners with American Specialty Health. Do you know if ASH is following suit with Cigna’s announcement to cover telehealth?
If they are licensed in California, would need to follow state mandate. If you have specific questions about your state, I am advising everyone to contact their respective state therapy association.
POS for virtual visits outpatient PT- Needs to be 11 or 02. Per Cigna link- It says with a GQ modifier and billed with a standard place of service code.
You would have to ask Cigna what they mean by “standard place of service code”. The standard place oof service code for telehealth is 02. Could Cigna mean standard place of service code to be an 11 as if they came to your facility? They could. I would go with 02.
You mentioned to use GQ as modifier to each CPT code on the claim form; but as I understand GQ is for videos not in real time. If we are using interactive audio/video telecommunications, shouldn’t that be GT? And can GT (or GQ) be still used in conjunction with 59?
Cigna and ASH mentions to use GQ, not me. I would tell you to follow the instructions provided by Cigna and ASH.
This is what our provider rep told us re. use of GQ modifier:
Regarding the GT modifier – Cigna was in the process of updating our telehealth policy prior to the Covid 19 pandemic that would allow for telehealth billing of some therapy codes. That came with a reduced reimbursement (not sure by how much) but we hadn’t rolled that out yet so that’s why you may not have heard about it yet. My understanding is that if you bill using the GT modifier, you will get the reduced rates that were loaded, while if you use the GQ modifier, you will get the same reimbursement as you would for a face to face visit. The GQ modifier and reimbursement will be in place while the pandemic continues and we will roll out our normal telehealth policy with the GT modifier with lower reimbursement to replace the GQ modifier at a later date.
Until it is in writing in a source document on their website, it is only speculation.