Cigna Updates Telehealth for Outpatient Therapy Services
Effective April 9, 2020, Cigna has updated their telehealth coverage policies for outpatient physical, occupational and speech-language pathology therapy services. Previously, Cigna only covered the following CPT codes:
For Physical Therapy: 97161, 97162, 97110 (only 2 units per telehealth visit)
For Occupational Therapy: 97165, 97166, 97110 (only 2 units per telehealth visit)
For Speech Therapy: 92507 and 92526
Per the update, Cigna will now cover the following CPT codes:
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Should therapists now use the GT modifier with Cigna, not the GQ, for synchronous telehealth services with this latest update? Thanks so much for all your information!
Cigna gives you 3 options for modifiers to append to the CPT code(s) on the claim form.
Great, thanks for the guidance.
Would these updates leave you to believe that the “only 2 units per telehealth visit” notation from the previous covered codes no longer exists either? I don’t know that our telehealth sessions would go that long but if we saw a patient for 45 mins via telehealth, would you believe we could charge 3 units of the appropriate timed unit with the updates Cigna has noted?
That is a decision you would need to make based on the updated guidelines.
I received this notice in an email from Cigna dated April 10, 2020
Virtual care billing updates and helpful quick links
We have seen the demand for virtual care increase, and have updated our virtual care guidance to allow providers to bill any code on their existing fee schedule virtually and be reimbursed at face-to-face rates.
Which leads me to believe that they have removed their limitations and clearly you can’t bill 97140 but it would appear that we can bill anything that is currently on our fee schedule and fits telehealth
Should we assume these changes apply to ASH as well?
As you know, I would never assume anything. I would recommend you contact ASH.
How do you interpret the comment “and if CMS covers it virtually”? CMS is covering therapy codes but not when billed by a physical, occupational and speech language pathologist… so do you feel with this statement that Cigna is following suit?
You would want to look at the CPT codes that CMS added as covered telehealth services back on March 30, 2020 and those would be the codes that Cigna would cover.
with the phase ‘and if CMS covers it virtually’ added does this exclude Hosptial Based OP that bill on a UB-04 form being covered since CMS only covers virtual services provided by Private Practice?
My standard answer is you must check with each insurance carrier as to whether they are paying for E-Visits, Telephone Services or Telehealth for claims submitted on a UB-04 claim form.
are you stating that Cigna would only allow evisits since that’s all that medicare allows for?
No, that is not what Cigna is saying.