Q: How does Cigna cover virtual care services as of January 1, 2021?

On January 1, 2021, we implemented a Virtual Care Reimbursement Policy that ensures permanent coverage of certain virtual care services.

Q: Why did Cigna implemen a new Virtual Care Reimbursement Policy?

We are committed to helping providers deliver care how, when, and where it best meets the needs of their patients. And as customers 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 wanted to implement a policy that ensures you can continue to receive ongoing reimbursement for virtual care that you deliver to your patients with Cigna commercial medical coverage.

Q: What will providers be reimbursed when they deliver covered virtual care services?

When all billing requirements are met, covered virtual care services will be reimbursed at 100% of face-to-face rates (i.e., parity). Please note that state and federal mandates, as well as customer benefit plan design, may supersede this guidance.

Q: Will Cigna always reimburse virtual care services at face-to-face rates?

For the immediate future, we will continue to reimburse virtual care services consistent with face-to-face rates. We will also continue to consider Centers for Medicare & Medicaid (CMS) guidance, industry standards, and affordability for our clients to help inform any potential future changes to our reimbursement approach. We also continue to work directly with providers to understand the financial implications that virtual care reimbursement may have on practices.

As our virtual care strategy evolves in the future, we are committed to remaining transparent with you about any potential changes to reimbursement.

Q: Does this policy include eConsults?

Yes. eConsults codes 99446-99449, 99451, and 99452 were added as reimbursable under this policy in March 2022. Previously, these codes were reimbursable as part of our interim COVID-19 accommodations.

Q: How was the list of covered codes determined?

Over the past several years – and accelerated during COVID-19 – we have collaborated with and sought feedback from many local and national medical societies, provider groups in our network, and key collaborative partners that have suggested certain codes and services that should be addressed in a virtual care reimbursement policy. We also referenced the current list of covered virtual care codes by the CMS to help inform our coverage strategy.

Through this feedback and research, we developed a list of covered services that we believe are most appropriate to be offered virtually across multiple specialties.

Q: Could the list of covered services change in the future?

Yes. We added a number of additional codes in March and April 2022 that are now eiligible for reimbursement. Please review the Virtual Care Reimbursement Policy for additional details on the added codes.

Further, we will 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 will use all feedback we receive to consider further updates to our policy.

Q: What technology requirements are there under this new policy?

Except for the telephone-only codes (99441-99443), all services must be interactive and use both audio and video internet-based technologies (synchronous communication) in order to be covered. Please note that all technology used must be secure and meet or exceed federal and state privacy requirements.

Q: What modifier(s) must providers use when billing virtual care services?

Modifier 95, GT, or GQ must be appended to the appropriate CPT^® or HCPCS procedure code(s) to indicate the service was for virtual care. Please note that providers only need to use one of these modifiers, and the modifiers do not have any impact on reimbursement. As long as one of these modifiers is included for the appropriate procedure code(s), the service will be considered to have been performed virtually.

Please note that we continue to request that providers do not bill with modifiers 93 or FQ at this time.

Q: What place of service (POS) do providers need to bill for virtual care services?

Providers should bill with POS 02 for all virtual care claims, as we updated our claims systems to ensure providers receive 100 percent of face-to-face reimbursement for covered virtual care when using POS 02.

Additionally, when you bill POS 02, your patients may also pay a lower cost-share for the virtual services they receive due to a recent change in some plan benefits.

Q: CMS recently came out with POS 10 for virtual care services when the patient is in the home setting. Does Cigna allow or prefer POS 10 to be billed for virtual care?

While POS 10 will be accepted by our claims system, Cigna requests POS 10 not be billed until further notice. Instead, we request that providers bill POS 02 for all virtual care in support of the new client benefit plan option that lowers cost-share for certain customers who receive virtual care.

Q: Are "store and forward" communications reimbursable under this policy?

No. Store and forward communications (e.g., email or fax communications) are not reimbursable.

Q: Is virtual care provided through Urgent Care centers reimbursable as part of this policy?

While as part of this policy, Urgent Care centers billing virtual care on a global S code is not reimbursable, we do continue to reimburse these services until further notice as part of our interim COVID-19 guidelines.

Q: Is virtual care provided through other facilities covered as part of this policy?

• Deliver services that are covered by the Virtual Care Reimbursement Policy;
• Bill consistently with the requirements of the policy; and
• Bill those services on a CMS-1500 form or electronic equivalent.

Please note that while virtual care services billed on a UB-04 claim will not typically be reimbursed under this policy, we continue to reimburse virtual care services billed on a UB-04 claim form until further notice as a COVID-19 accommodation when the services:

• Are reasonable to be provided in a virtual setting; and
• Are reimbursable per a provider’s contract; and
• Use synchronous technology (i.e., audio and video) – except 99441 - 99443, which are audio-only services

Please note that existing reimbursement policies will apply and may affect claims payment (e.g., R30 – E&M Services).

Q: Which customers does this policy apply to?

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.

Q: What is the customer cost-share for virtual care compared to in-person care?

When a customer receives virtual care services from their regular doctor (or any other provider) as part of this policy – and when the provider bills with POS 02 – customers with certain benefit plans may have a lower cost-share. All other customers will have the same cost-share as if they received the services in-person from that same provider.

Please note that customer cost-share and out-of-pocket costs may vary for services customers receive through our virtual care vendor network (e.g., MDLive).

Q: Will customers be able to search our directory for a provider who offers virtual care?

No. At this time, providers who offer virtual care will not be specially designated within our public provider directories. However, this added functionality is planned for a future update.

Q: Does this policy also apply to non-participating providers?

Yes. The Virtual Care Reimbursement Policy also applies to non-participating providers. Non-participating providers will be reimbursed consistent with how they would be reimbursed if the service was delivered in-person.

Q: Does this policy replace Cigna’s virtual care vendor network?

No. One of our key goals is to help customers connect to affordable, predictable, and convenient care anytime, anywhere. Therefore, to increase convenient 24/7 access to care if a customer’s preferred provider is unavailable in-person or virtually, covered virtual care is also available through national virtual care vendors like MDLive.

Q: What should providers do if they have additional questions about our Virtual Care Reimbursement Policy?

For additional information about our Virtual Care Reimbursement Policy, providers can contact their provider representative or call Cigna Customer Service anytime at 800.88Cigna (800.882.4462).

Q: Does this policy replace Cigna's interim COVID-19 virtual care guidelines?

No. The interim COVID-19 virtual care guidelines were solely in place through December 31, 2020, and this new policy took effect on January 1, 2022.

Additionally, certain virtual care services and accommodations that are not generally reimbursable under the Virtual Care Reimbursement Policy remain reimbursable as part of our continued interim COVID-19 virtual care guidelines until further notice. This includes:

• Facilities to bill on a UB-04 claim form
• Most synchronous technology to be used (e.g., FaceTime, Skype, Zoom, etc.)
• Preventive care services (99381-99387 and 99391-99397)
• Skilled nursing facility codes (99307-99310) [Effective with January 29, 2022 dates of service]

Q: What was covered through Cigna's interim COVID-19 virtual care guidelines?

Please refer to the interim COVID-19 virtual care guidelines for a complete outline of our interim COVID-19 virtual care coverage.