Virtual Care

Last Updated October 16th, 2020

Staying connected with your patients through virtual care services

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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 are pleased to announce our 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 remain in place until December 31, 2020. If it is necessary to extend that interim coverage without change based on an extended period health emergency period, our new permanent Virtual Care Reimbursement policy may be implemented at a later date. If this happens we will communicate these updates as necessary. Please know that we are committed to ensuring continued access to virtual care for you and your patients.

2. The Virtual Care Reimbursement Policy 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.

  • For more information about current Cigna 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.



Services reimbursed

Our new policy allows for reimbursement of a variety of services typically performed in an office setting that are appropriate to also perform virtually.


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.



Billing Example

  • Service performed: Office or other outpatient visit for the evaluation and management of a new patient

  • CPT code billed: 99202

  • Modifier appended to billed code: 95, GT, or GQ

  • Place of service billed: 11

  • Technology used: Audio and video

  • Reimbursement received (if covered): 100% of face-to-face rate

  • Customer cost-share: Applies consistent with face-to-face visit


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, services will be reimbursed consistent with face-to-face rates (i.e., parity) to ensure providers continue to receive fair reimbursement as we recover from COVID-19.3


3. Please note state and federal mandates, as well as customer benefit plan design, may supersede this guidance.



Reimbursement requirements

  • 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).
  • Billing POS 02 for virtual services may result in reduced payment or denied claims. Therefore, providers should bill a typical place of service (e.g., POS 11) to ensure they receive the same reimbursement as they typically get for a face-to-face visit.
  • 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.



Additional Information

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 (800.882.6642).



Virtual care through our vendor network

One of our key goals is to help your patients connect to affordable, predictable, and convenient care anytime, anywhere. To increase convenient 24/7 access to care if a patient’s preferred provider is unavailable in-person or virtually, our virtual care platform also offers solutions that include national virtual care vendors like MDLive.

The role you play

In addition to the in-office care that you deliver today, we encourage you to consider offering virtual care to your patients with Cigna coverage as well – and ensure they’re aware that you can continue to offer ongoing covered virtual care as they need it and as it’s medically appropriate.

We hope you join us in our journey to offer our customers increased access to virtual care and appreciate your commitment to work with us as our virtual care platform continues to evolve to the meet the needs of our providers, customers, and clients.



Frequently Asked Questions

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Cigna's approach to covering virtual care

Reimbursement

Covered codes

Requirements of policy

Facility coverage

Customer experience

General questions

Virtual care COVID-related questions