Staying connected with your patients through virtual care services
We are committed to helping you to deliver care how, when, and where it best meets the needs of your patients. And as your patients seek more convenient and safe care options, we continue to see growing interest in virtual care (i.e., telehealth) – especially from consumers and their providers who want to ensure they have greater access and connection to each other.
Because we believe virtual care has the potential to help you attract and retain patients, reduce access barriers, and contribute to your ability to provide the right care at the right time, we implemented a Virtual Care Reimbursement Policy for commercial medical services, effective January 1, 2021.1 This policy ensures you can continue to receive ongoing reimbursement for virtual care provided to your patients with Cigna commercial medical coverage.2
1. Please note that our interim COVID-19 virtual care guidelines were in place until December 31, 2020. Therefore, please refer to those guidelines for services rendered prior to January 1, 2021.
2. The Virtual Care Reimbursement Policy only applies to services provided to commercial medical customers, including those with Individual & Family Plans (IFP). Evernorth Behavioral Health and Cigna Medicare Advantage customers continue to have covered virtual care services through their own separate benefit plans.
- For more information about current Evernorth Behavioral Health virtual care guidance, please visit CignaforHCP.com > Resources > Behavioral Resources > Doing Business with Cigna > COVID-19: Interim Guidance.
- For more information about current Cigna Medicare Advantage virtual care guidance, please visit medicareproviders.cigna.com > Billing Guidance and FAQ > Telehealth.
Our policy allows for reimbursement of a variety of services typically performed in an office setting that are appropriate to also perform virtually. 3
Common services included in the policy
- Routine check-ups
- General wellness visits
- New patient exams
- Behavioral assessments
Common codes included in the policy
- Outpatient E&M codes for new and established patients (99202-99215)
- Physical and occupational therapy E&M codes (97161-97168)
- Telephone-only E&M codes (99441-99443)
- Annual wellness visit codes (G0438 and G0439)
For a complete list of the services that will be covered, please review the Virtual Care Reimbursement Policy.
Commitment to continued updates
Please know that we continue to monitor virtual care health outcomes and claims data – as well as provider, customer, and client feedback – to ensure that our reimbursement and coverage strategy continues to meet the needs of those we serve. To this end, we appreciate the feedback and deep collaboration we’ve had with provider groups and medical societies regarding virtual care. We are committed to continuing these conversations and will use all feedback we receive to consider updates to our policy, as necessary.
3. Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance.
Billing and reimbursement requirements
For services included in our Virtual Care Reimbursement Policy, a number of general requirements must be met for Cigna to consider reimbursement for a virtual care visit. When all requirements are met, covered services are currently reimbursed at 100% of face-to-face rates (i.e., parity).
- Services must be on the list of eligible codes contained within in our Virtual Care Reimbursement Policy.
- Claims must be submitted on a CMS-1500 form or electronic equivalent.
- Modifier 95, GT, or GQ must be appended to the virtual care code(s).
- Claims should be billed POS 02.
- Except for the noted phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication).4
- Store and forward communications (e.g., email or fax communications) are not reimbursable.
For a complete list of billing requirements, please review the Virtual Care Reimbursement Policy.
4. All synchronous technology used must be secure and meet or exceed federal and state privacy requirements.
For additional information about our Virtual Care Reimbursement Policy, please review the policy, contact your provider representative, or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462).