Q: Does Cigna cover the administration of the COVID-19 vaccine?

Yes. Cigna covers the administration of the COVID-19 vaccine with no customer cost-share (i.e., no deductible or co-pay) when delivered by any provider or pharmacy.

Q: How should providers bill for the administration of the COVID-19 vaccine, and what will they be reimbursed?

After the emergency use authorization (EUA) or licensure of each COVID-19 vaccine product by the FDA, CMS will identify the specific vaccine code(s) along with the specific administration code(s) for each vaccine that should be billed.

When specific contracted rates are in place for COVID-19 vaccine administration codes, Cigna will reimburse covered services at those contracted rates. When no specific contracted rates are in place, Cigna will reimburse the administration of all covered COVID-19 vaccines at the established national CMS rates noted below when claims are billed under the medical benefit to ensure timely, consistent, and reasonable reimbursement.

Q: Will Cigna reimburse providers for vaccines administered in a home setting?

Yes. Consistent with CMS guidance, Cigna will reimburse providers for COVID-19 vaccines they administer in a home setting. Providers should bill the relevant vaccine administration code (e.g., 0001A, 0002A, etc.) and the home vaccine administration code (M0201) on the same claim under the medical benefit.

When specific contracted rates are in place for vaccine administration services, Cigna will reimburse covered services at those contracted rates. When no specific contracted rates are in place, providers will be reimbursed $40 per dose for general vaccine administration and an additional $35.50 per dose for administering it in a home setting for total reimbursement of $75.50 per vaccine dose.

Q: Will Cigna cover the cost of the administration of the vaccine for non-participating providers?

Yes. Cigna will cover the administration of the COVID-19 vaccine with no customer cost-share even when administered by a non-participating provider following the guidance above.

Q: Do providers have to bill a CS modifier in order for cost-share to be waived for the administration of the COVID-19 vaccine?

No. No additional modifiers are necessary. Billing the appropriate administration code will ensure that cost-share is waived.

Q: Will Cigna reimburse providers for the vaccine itself?

No. As the government is providing the initial vaccine doses free of charge to health care providers, Cigna will not reimburse providers for the cost of the vaccine itself. Providers can, however, bill the vaccine code (e.g., 91300 for the Pfizer vaccine or 91301 for the Moderna vaccine) with a nominal charge (e.g., $.01), but it is not required to be billed in order to receive reimbursement for the administration of the vaccine.

Q: If a provider administers the vaccine in a site other than their typical location, will the vaccine administration be covered?

Yes. Providers who are administering the COVID-19 vaccine in a site other than their typical office or facility setting (e.g., at a sports complex) can bill us under their regular facility location. No additional credentialing or notification to Cigna is required.

Q: If a participating provider group brings in non-credentialed providers to help administer the vaccine, do those providers need to be credentialed under the group in order to bill for the administration of the COVID-19 vaccine?

No. In these cases, the non-credentialed provider can bill under the group assuming they are practicing within state laws to administer the vaccine.

Q: Does Cigna allow roster billing for the COVID-19 vaccine?

Yes. Cigna will accept roster billing from providers who are already mass immunizers and bill Cigna today in this way for other vaccines (e.g., seasonal flu vaccine), as well as from providers and state agencies that are offering mass vaccinations for their local communities, provided the claim roster includes sufficient information to identify the Cigna customer.

Q: Can providers bill the patient for the vaccine or the administration of it?

No. Providers that receive the COVID-19 vaccine free of charge from the federal government are prohibited from seeking reimbursement from consumers for vaccine administration costs whether as cost sharing or balance billing. Providers that administer vaccinations to patients without health insurance or whose insurance does not provide coverage of vaccination administration fees, may be able to file a claim with the provider relief fund, but may not charge patients directly for any vaccine administration costs.

Q: Can providers bill an E&M service along with the vaccine administration?

Maybe. Similar to other vaccination administration (e.g., a flu shot), an E&M service and vaccine administration code should only be billed when a significant and separately identifiable E&M visit was performed at the same time as the administration of the vaccine. Providers can check the Clear Claim Connection^TM tool on CignaforHCP.com to determine if both the E&M and vaccine administration are allowed for the specific service the provider rendered.

Q: Is precertification/prior authorization required for the vaccine administration?

No.

Q: How should an urgent care center bill for COVID-19 vaccine administration?

Similar to other providers and facilities, urgent care centers should bill just the appropriate COVID-19 vaccine administration code when that is the only service they are providing.

Consistent with our reimbursement strategy for all other providers, urgent care centers will be reimbursed for covered vaccine administration services at contracted rates when specific contracted rates are in place for vaccine administration codes. When no specific contracted rates are in place, Cigna will reimburse the administration of all EUA vaccines at the established national CMS rates when claims are submitted under the medical benefit to ensure timely, consistent, and reasonable reimbursement.

Urgent care centers can bill their global S code when a significant and separately identifiable service is performed at the same time as the administration of the vaccine, but will only be reimbursed for both services when their contract allows it (similar to how they may be reimbursed today for flu shot administration). Otherwise, urgent care centers will be reimbursed only their global fee when vaccine administration and a significant and separately identifiable service is performed.

Q: How can providers get reimbursed for administering the vaccine to patients without health insurance?

Per CMS, individuals without health insurance or whose insurance does not provide coverage of the vaccine can also get COVID-19 vaccine at no cost. Providers administering the vaccine to individuals without health insurance or whose insurance does not provide coverage of the vaccine can request reimbursement for the administration of the COVID-19 vaccine through the Provider Relief Fund.

Q: Does Cigna believe that the COVID-19 vaccines are safe and effective?

Yes. Cigna ultimately looks to the FDA, CDC, and ACIP to determine these factors. However, we believe that FDA and EUA-approved vaccines are safe and effective, and encourage our customers to get vaccinated.

Q: Where can individuals get additional information about the COVID-19 vaccines?

Additional information about the COVID-19 vaccines, including planning for a vaccine, vaccine development, getting vaccinated, and vaccine safety can be found on the CDC website.

Q: Can providers deliver covered virtual care services to patients with commercial medical Cigna coverage?

Yes. Providers could deliver any face-to-face service on their fee schedule virtually, including those not related to COVID-19, for dates of service through December 31, 2020. This includes providers who typically deliver services in a facility setting. If a provider was reimbursed for a face-to-face service per their existing fee schedule, then they were reimbursed the same amount even if they delivered the service virtually.

Effective for dates of service on and after January 1, 2021, we implemented a new R31 Virtual Care Reimbursement Policy. Please visit CignaforHCP.com/virtualcare for additional information about that policy.

Please note that we continue to closely monitor and audit claims for inappropriate services that could not be performed virtually (e.g., acupuncture, all surgical codes, anesthesia, radiology services, laboratory testing, administration of drugs and biologics, infusions or vaccines, EEG or EKG testing, etc.).

Q: How does Cigna apply cost-share for virtual care services?

For covered virtual care services cost-share will apply as follows:

• For COVID-19 related screening (i.e., quick phone or video consult): No cost-share for customers through at least May 11, 2023
• For non-COVID-19 related services (e.g., oncology visit, routine follow-up care): Standard customer cost-share

Q: Does Cigna cover code Q3014 to reimburse a telehealth originating site or facility fee?

No. Cigna does not reimburse an originating site of service fee or facility fee for telehealth visits, including for code Q3014, as they are not a covered benefit. This code will only be covered where state mandates require it.

Q: Does Cigna allow physical, occupational, and speech therapists (PT/OT/ST) to provide virtual care?

Yes. PT/OT/ST providers could deliver virtual care for any service that was on their fee schedule for dates of service through December 31, 2020. PT/OT/ST providers should continue to submit virtual claims with a GQ, GT, or 95 modifier and POS 02, and they will be reimbursed at their face-to-face rates.

Certain PT, OT, and ST virtual care services remain reimbursable under the R31 Virtual Care Reimbursement Policy.

Additionally, if a provider typically bills services on a UB-04 claim form, they can also provide those services virtually until further notice. In these cases, the provider should bill as normal on a UB-04 claim form with the appropriate revenue code and procedure code, and also append the GQ, GT, or 95 modifier.

Important notes

• While we encourage PT/OT/ST providers to follow CMS guidance regarding the use of software programs for virtual care, we are not requiring the use of any specific software program at this time.
• We maintain all current medical necessity review criteria for virtual care at this time.
• Our national ancillary partner American Specialty Health (ASH) is applying the same virtual care guidance, so any provider participating through ASH and providing PT/OT services to Cigna customers is covered by the same guidance.

Q: Which modifiers should providers bill for virtual care visits?

Cigna allows modifiers GQ, GT, or 95 to indicate virtual care for all services. We request that providers do not bill any other virtual modifier, including 93 or FQ, until further notice.

Q: What place of service code should providers bill for virtual care visits?

For virtual care services billed on and after July 1, 2022, we request that providers bill with POS 02.

Q: What will providers be reimbursed for covered virtual care services?

All covered virtual care services will continue to be reimbursed at 100% of face-to-face rates, even when billed with POS 02.

Q: Can providers offer quick phone consults for their patients related to COVID-19 or other necessary services?

Yes. Providers can bill code G2012 for a quick 5-10 minute phone conversation as part of our R31 Virtual Care Reimbursement Policy, with cost-share waived through at least May 11, 2023 for customers when the conversation is related to COVID-19. This will allow for quick telephonic consultations related to COVID-19 screening or other necessary consults, and will offer appropriate reimbursement to providers for this amount of time.
Please review our R33 COVID-19 Interim Billing Guidelines policy for ICD-10 diagnosis code requirements to have cost-share waived for G2012.

Q: Does Cigna cover codes 99441-99443?

Yes. We covered codes 99441-99443 as part of these interim COVID-19 guidelines, and continue to cover them as part of the R31 Virtual Care Reimbursement Policy. As a reminder, standard customer cost-share applies for non-COVID-19 related services.

Q: Does Cigna allow virtual visits to pre-screen patients for return-to-work purposes?

Usually not. Similar to non-diagnostic COVID-19 testing services, Cigna will only cover non-diagnostic return-to-work virtual care services when covered by the client benefit plan. Because most standard Cigna client benefit plans do not extend coverage to screening services when performed for employment reasons (e.g., occupational physical examination), virtual care screening services will generally not be covered solely for return-to-work purposes.

Q: Does Cigna allow urgent care centers to provide virtual care services?

Yes. While virtual care provided by an urgent care center is not covered per our R31 Virtual Care Reimbursement Policy, we continue to reimburse urgent care centers for delivering virtual care until further notice as part of our interim COVID-19 virtual care accommodations.

Urgent care centers can also bill their typical S9083 code for services that are more complex than a quick telephone call. In these cases, the urgent care center should append a GQ, GT, or 95 modifier, and we will reimburse the full face-to-face rate for insured and Non-ERISA ASO customers in states where telehealth parity laws exist. For all other customers, we will reimburse urgent care centers a flat rate of $88 per virtual visit.

Please note that routine care will be subject to cost-share, while COVID-19 related care will be reimbursed with no cost-share.

Q: Could providers who typically deliver services in a facility setting perform virtual services through December 31, 2020?

Yes. If a provider typically delivered face-to-face services in a facility setting, that provider could also deliver any appropriate service virtually consistent with existing Cigna policies through December 31, 2020 dates of service. In these cases, providers should bill their regular face-to-face codes that are on their fee schedule, and add the GQ, GT, or 95 modifier to indicate the services were performed virtually. A provider should bill on the same form they usually do (e.g., CMS 1500 or UB-04) as when they provide the service face-to-face.

For example, if a dietician or occupational therapist would typically see a patient in an outpatient setting, but that service is now provided virtually, that dietician or occupational therapist would bill the same way they do for that face-to-face visit – using the existing codes on their fee schedule and existing claim form they typically bill with (e.g., CMS 1500 or UB-04) – and append the GQ, GT, or 95 modifier.

Similarly, if a cardiologist is brought in to consult in a face-to-face setting within a facility setting, that cardiologist can also provide services virtually billing a face-to-face evaluation and management (E&M) visit (the same code[s] on their fee schedule and the same claim form [e.g., CMS 1500 or UB-04]). They would also need to append the GQ, GT, or 95 modifier to indicate the service was performed virtually.

If a provider typically bills services on a UB-04 claim form, they can also provide those services virtually. In these cases, the provider should bill as normal on a UB-04 claim form with the appropriate revenue code and procedure code, and also append the GQ, GT, or 95 modifier.

In all the above cases, the provider will be reimbursed consistent with their existing fee schedule for face-to-face rates.

Q: Can providers who typically deliver services in a facility setting perform virtual services on and after January 1, 2021?

In certain cases, yes. While the R31 Virtual Care Reimbursement Policy that went into effect on January 1, 2021 only applies to claims submitted on a CMS-1500 claim form, we will continue to reimburse virtual care services billed on a UB-04 claim form until further notice when the services:

• Are reasonable to be provided in a virtual setting; and
• Are reimbursable per a providers 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).

While services billed on a UB-04 are out of scope for the new policy, we will continue to evaluate facility-based services for future policy updates.

Q: Could providers perform inpatient virtual E&M services? If so, how would they bill?

Yes. Inpatient virtual E&M visits, where the provider virtually connects with the patient, were reimbursable through December 31, 2020 dates of service. For example, an infectious disease specialist could provide a virtual consultation for an ICU patient, document the level of care provided, bill the appropriate face-to-face E&M code with modifier GQ, GT, or 95, and be reimbursed at the face-to-face rate.

Q: Did Cigna cover neuropsychological and psychological testing in a virtual setting?

Yes. Through December 31, 2020 dates of service, providers could deliver virtual neuropsychological and psychological testing services and bill their regular face-to-face CPT^® codes that were on their fee schedule . Providers should append the GQ, GT, or 95 modifier and Cigna will reimburse them consistent with their face-to-face rates. Standard cost-share will apply for the customer, unless waived by state-specific requirements.

Q: Can providers deliver home health services virtually, including after acute inpatient, acute rehab (AR), or skilled nursing facility (SNF) discharge? Can home care services be provided by virtual care after an acute inpatient discharge?

Yes. Certain home health services can be provided virtually using synchronous communication as part of our R31 Virtual Care Reimbursement Policy. A home health care provider should bill one of the covered home health codes for virtual services (G0151, G0152, G0153, G0155, G0157, G0158, G0299, G0300, G0493, S9123, S9128, S9129, and S9131) along with POS 12 and a GT or 95 modifier to identify that the service(s) were delivered using both an audio and video connection.

If the home health service(s) are done for COVID-19 related treatment, cost-share will be waived for covered services through February 15, 2021 when providers bill ICD-10 code U07.1, J12.82, M35.81, or M35.89.

The ordering provider should use the standard, existing process to submit home health orders to eviCore healthcare. When an order for home health services is clinically appropriate for telehealth services, the care will be offered through a virtual visit unless the order indicates that home health services must be in-person or the patient refuses the virtual visit.

In addition, the discharging provider or primary care physician can provide the post discharge visit virtually if appropriate.

Q: Does Cigna have any technological requirements for virtual care?

No. We did not make any requirements regarding the type of technology used. Phone, video, FaceTime, Skype, Zoom, etc. were all appropriate to use through December 31, 2020.

For the R31 Virtual Care Reimbursement Policy, effective January 1, 2021, we continue to not make any requirements regarding the type of synchronous technology used until further notice. Therefore, FaceTime, Skype, Zoom, etc. all continue to be appropriate to use at this time.

Q: Do any other services that were included in the above interim COVID-19 virtual care guidelines, but that are not included in the R31 Virtual Care Reimbursement Policy, remain in effect?

Yes. Until further notice, we will continue to made additional virtual care accommodations by allowing:

• Facilities to bill on a UB-04 claim form
• Urgent care centers to offer virtual care when billing with a global S9083 code
• Most synchronous technology to be used (e.g., FaceTime, Skype, Zoom, etc.)
• Preventive care codes (99381-99387 and 99391-99397)
• Skilled nursing facility codes (99307-99310) (Effective with January 29, 2022 dates of service)

• A quick 5- to 10-minute telephone conversation between a provider and their patient (G2012)
• eConsults (99446-99449, 99451, and 99452)
• Virtual home health services (G0151, G0152, G0153, G0155, G0157, G0158, G0299, G0300, G0493, S9123, S9128, S9129, and S9131)

Q: What are eConsults?

eConsults are when a treating health care provider seeks guidance from a specialist physician through electronic means (e.g., phone, Internet, EHR consultation) to help manage care that is beyond the treating health care provider's usual practice.

Typical examples include:

• Primary care physician to specialist requesting input from a cardiologist, psychiatrist, pulmonologist, allergist, dermatologist, surgeon, oncologist, etc.
• Specialist to specialist (e.g., ophthalmologist requesting consultation from a retina specialist, orthopedic surgeon requesting consultation from an orthopedic surgeon oncologist, cardiologist with an electrophysiology cardiologist, and obstetrician from a maternal fetal medicine specialist)
• Hospitalist requests an infectious disease consultation for pulmonary infections to guide antibiotic therapy

Q: Does Cigna allow eConsults for COVID-19 and non-COVID-19 related consults?

Yes. Effective for dates of service on and after March 2, 2020 until further notice, Cigna will cover eConsults when billed with codes 99446-99449, 99451 and 99452 for all conditions.

Q: Is cost-share waived for eConsults?

Cost share is waived for all covered eConsults through December 31, 2021. Effective January 1, 2022, eConsults remain covered, but cost-share applies for all covered services.

Q: How do providers need to bill eConsult codes?

Providers should bill one of the above codes, along with:

• POS 02;
• The ICD-10 code that represents the primary condition, symptom, or diagnosis as the purpose of the consult; and
• Modifier CS for COVID-19 related treatment. No virtual care modifier is needed given that the code defines the service as an eConsult.

Q: What additional guidelines does Cigna have for eConsults?

• The patient may be either a new patient to the consultant or an established patient with a new problem or an exacerbation of an existing problem.
• If the telephone, Internet, or electronic health record consultation leads to a transfer of care or other face-to-face service (e.g., a surgery, a hospital visit, or a scheduled office evaluation of the patient) within the next 14 days or next available appointment date of the consultant, these codes should not be billed.
• If more than one telephone, Internet, or electronic health record contact(s) is required to complete the consultation request (e.g., discussion of test results), the entirety of the service and the cumulative discussion and information review time should be billed with a single code.
• Telephone, Internet, or electronic health record consultations of less than five minutes should not be billed.
• The codes may only be billed once in a seven day time period.
• The codes should not be billed if the sole purpose of the consultation is to arrange a transfer of care or a face-to-face visit.

Q: Will providers need a patient's consent to conduct an eConsult?

No. Providers will not need a specific consent from patients to conduct eConsults. HIPAA does not require patient consent for consultation and coordination of care with health care providers in the ordinary course of treatment for their patients.

Q: If a hospitalist is the treating provider, is the consult paid separately?

No. If a hospitalist is the treating provider, they would not be reimbursed for two services on the same day, as only one service is reimbursed per day, regardless of billing method.

Q: Will Cigna allow eConsults in an inpatient and outpatient setting?

Yes. Cigna will not make any limitation as to the place of service where an eConsult can be used.

Q. Does Cigna cover diagnostic laboratory tests for COVID-19?

Yes. To help remove any barriers to receive testing, Cigna will cover any diagnostic molecular or antigen diagnostic test for COVID-19, including rapid tests and saliva-based tests, through at least May 11, 2023.

In addition, these requirements must be met:

• The test is FDA approved or cleared or have received Emergency Use Authorization (EUA); AND
• The test is run in a laboratory, office, urgent care center, emergency room, drive-thru testing site, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU. Note that high-throughput tests may only be run in a high-complexity laboratory; AND
• The laboratory or provider bills using the codes in our interim billing guidelines and testing coverage policy.

This guidance applies for all providers, including urgent care centers and emergency rooms, and applies to customers enrolled in Cigna's employer-sponsored plans in the United States and the Individual & Family plans available through the Affordable Care Act. Organizations that offer Administrative Services Only (ASO) plans will be opted in to waiving cost-share for this service as well.

Important notes:

• When the tests are performed for general population or public health surveillance, for employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19, Cigna will generally not cover in-vitro molecular, antigen, or antibody tests for asymptomatic individuals.
• In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. Cigna will determine coverage for each test based on the specific code(s) the provider bills.
• Cigna follows CMS rules related to the use of modifiers.

For additional information about Cigna's coverage of medically necessary diagnostic COVID-19 tests, please review the COVID-19 In Vitro Diagnostic Testing coverage policy.

Q: Does Cigna cover at-home and over-the-counter testing kits?

Yes. Consistent with federal guidelines for private insurers, Cigna commercial will cover up to eight over-the-counter (OTC) diagnostic COVID-19 tests per month (per enrolled individual) with no out-of-pocket costs for claims submitted by a customer under their medical benefit. This coverage began January 15, 2022 and continues through at least the end of the public health emergency (PHE) period (May 11, 2023). For more information, please visit Cigna.com/Coronavirus.

Please note that while Cigna Medicare Advantage plans do fully cover the costs for COVID-19 tests done in a clinical setting, costs of at-home COVID-19 tests are not a covered benefit.

However, CMS published additional details about their new initiative to cover FDA approved, authorized, or cleared over-the-counter (OTC) COVID-19 tests at no cost.

• As of April 4, 2022, individuals with Medicare Part B and Medicare Advantage plans can get up to eight OTC tests per calendar month from participating pharmacies and health care providers for the duration of the COVID-19 public health emergency (PHE).
• This new initiative enables payment from original Medicare for submitted claims directly to participating eligible pharmacies and other health care providers, which allows Medicare beneficiaries to receive tests at no cost.
• For more information, including details on how you can get reimbursed for these tests from original Medicare when you directly supply them to your patients with Part B or Medicare Advantage plans, please review the CMS guidance.

Q: Are OTC tests for all purposes covered with no cost-share?

No. COVID-19 OTC tests used for employment, travel, participation in sports or other activities are not covered under this mandate.

Q: Does Cigna reimburse health care providers directly for OTC COVID-19 tests?

No. Cigna commercial and Cigna Medicare Advantage will not directly reimburse claims submitted under the medical benefit by retailers or by health care providers like hospitals, urgent care centers, and primary care groups for OTC COVID-19 tests, including when billed with CPT code K1034. Cigna will only reimburse claims for covered OTC COVID-19 tests submitted by customers under their medical benefit and by certain pharmacy retailers under the pharmacy benefit, as elected by clients. Therefore, your patients with Cigna commercial coverage can purchase OTC tests from a health care provider and seek reimbursement by billing Cigna directly following our published guidance.

Additionally, Cigna also continues to provide coverage for COVID-19 tests that are administered with a providers involvement or prescription after individualized assessment as outlined in this section and in Cignas COVID-19 In Vitro Diagnostic Testing coverage policy.

Q: When covered, what does Cigna reimburse for diagnostic testing services performed by a provider?

When specific contracted rates are in place for diagnostic COVID-19 lab tests, Cigna will reimburse covered services at those contracted rates. When no specific contracted rates are in place, Cigna will reimburse all covered COVID-19 diagnostic tests consistent with CMS reimbursement to ensure consistent, timely, and reasonable reimbursement.

Reimbursement for codes that are typically billed include:

* Effective January 1, 2021

Q: Did Cigna align with CMS update for reimbursing high-throughput COVID-19 tests?

Yes. Cigna covers and reimburses providers for high-throughput COVID-19 laboratory testing consistent with the updated CMS reimbursement guidelines. Therefore, as of January 1, 2021, we are reimbursing providers $75 for covered high-throughput laboratory tests billed with codes U0003 and U0004. Also consistent with CMS, we will reimburse providers an additional $25 when they return the result of the test to the patient within two days and bill Cigna code U0005.

Q: Does Cigna cover testing for asymptomatic individuals?

Cigna does not generally cover tests for asymptomatic individuals when the tests are performed for general public health surveillance, for employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19.

ICD-10 diagnosis codes that generally reflect non-covered services are as follows. Please note that this list is not all inclusive and may not represent an exact indication match.

• Return-to-work (Z02.79)
• Return-to-school (Z02.0)
• Participation in sports (Z02.5)
• Pre-employment, (Z02.1)
• Routine and/or executive physicals (Z02.89)

In compliance with federal agency guidance, however, Cigna covers individualized COVID-19 diagnostic tests without cost-share through at least May 11, 2023 for asymptomatic individuals when referred by or administered by a health care provider.

In all cases, providers should bill the COVID-19 test with the diagnosis code that is appropriate for the reason for the test. Cigna will determine coverage for each test based on the specific code(s) the provider bills. Please review our COVID-19 In Vitro Diagnostic Testing coverage policy for a list of additional services and ICD-10 codes that are generally not covered.

Q: Does Cigna cover non-diagnostic COVID-19 testing for general public health surveillance, for employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19?

It depends upon the clients benefit plan, but as noted above, testing is usually not covered for these purposed because most standard Cigna client benefit plans do not cover non-diagnostic tests for these non-diagnostic reasons. Cigna will only cover non-diagnostic PCR, antigen, and serology (i.e., antibody) tests when covered by the client benefit plan.

Q: How does a provider know if the patients benefit plan allows coverage of COVID-19 testing for these purposes?

Providers can call Cigna customer service at 1.800.88Cigna (882.4462) to check a patients eligibility information, including if their plan offers coverage for these purposes.

Q: How should a provider submit a claim to indicate it was for COVID-19 return-to-work or return-to-school purposes?

When performing tests for these purposes, providers should bill the appropriate laboratory code (e.g., U0002) following our existing billing guidelines and testing coverage policy, and use the diagnosis code Z02.79 to indicate the test was performed for return-to-work or diagnosis code Z02.0 to indicate the test was performed for return-to-school purposes.

Q: Does Cigna cover COVID-19 laboratory testing codes U0003 and U0004?

Yes. Cigna covers FDA EUA-approved laboratory tests. For dates of service April 14, 2020 through at least May 11, 2023, Cigna will cover U0003 and U0004 with no customer cost-share when billed by laboratories using high-throughput technologies as described by CMS.

Q: Who can perform these high-throughput laboratory tests?

Generally, only well-equipped commercial laboratories and hospital-based laboratories will have the necessary equipment to offer these tests. We do not expect smaller laboratories or doctors' offices to be able to perform these tests.

Q: When should U0003 and U0004 be billed?

Per CMS, U0003 and U0004 should be used to bill for tests that would typically be billed by 87635 and U0002 respectively, except for when the tests are performed with these high-throughput technologies. Neither U0003 nor U0004 should be used for tests that are used to detect COVID-19 antibodies.

Q: How does a provider bill Cigna for a uniform screening (questionnaire) followed by a COVID-19 test?

• If a provider administers a quick uniform screening (questionnaire) that does not result in a full evaluation and management service of any level, and then performs a COVID-19 test OR a collection service, they should bill only the laboratory code OR collection code.
• When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance.
• When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance.
• When specimen collection is done in addition to other services on the same date of service for the same patient, reimbursement will not be made separately for the specimen collection (whether billed on the same or different claims).
• If specimen collection and a laboratory test are billed together, only the laboratory test will be reimbursed.

Please note that this guidance applies to drive through testing as well, and includes services performed by a free-standing emergency room or any other provider. Billing an evaluation and management (E/M) code when that level of service is not provided is fraudulent billing and is expressly prohibited.

Q: Can an urgent care center bill a laboratory code or specimen collection code in addition to their standard S9083 code?

No. Urgent care centers will not be reimbursed separately when they bill for multiple services.

• When multiple services are billed along with S9083, only S9083 will be reimbursed.
• When only specimen collection is performed, code G2023 or G2024 should be billed following our billing guidance.
• When only laboratory testing is performed, laboratory codes like 87635, 87426, U0002, U0003, or U0004 should be billed following our billing guidance.
• When specimen collection is done in addition to other services on the same date of service for the same patient, reimbursement will not be made separately for the specimen collection (when billed on the same or different claims).
• If specimen collection and a laboratory test are billed together, only the laboratory test will be reimbursed.
• If an urgent care center performs an evaluation and treatment service, collects a specimen for COVID-19, and runs the laboratory test, they should bill just their per-visit S9083 code or just the laboratory code.
• If an urgent care center administers a quick uniform screening (questionnaire) that does not result in a full evaluation and management service of any level and then performs a COVID-19 test OR a collection service, they should bill only the laboratory code OR collection code.

Q: Does Cigna cover specimen collection codes G2023 and G2024?

Yes. These codes will be covered with no customer cost-share through at least May 11, 2023 when billed by a provider or facility.

When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. When no specific contracted rates are in place, Cigna will reimburse covered services consistent with the CMS reimbursement rates noted below to ensure timely, consistent and reasonable reimbursement.

• G2023: $23.46
• G2024: $25.46

Q: Does Cigna cover specimen collection code C9803?

Yes. Cigna covers C9803 with no customer cost-share for a hospital outpatient clinic visit specimen collection, including drive-thru tests, through at least May 11, 2023 only when billed without any other codes. When specimen collection is done in addition to other services on the same date of service for the same patient, reimbursement will not be made separately for the specimen collection (when billed on the same or different claims).
When specific contracted rates are in place for COVID-19 specimen collection, Cigna will reimburse covered services at those contracted rates. When no specific contracted rates are in place, we will reimburse this code at $22.99 consistent with CMS pricing to ensure consistent, timely, and reasonable reimbursement. In all cases, reimbursement will only be provided for hospital outpatient services performed in a clinic setting (including drive-thru testing sites) when billed on a UB-04 claim form with an appropriate revenue code.

Q: Who can bill these specimen collection codes?

Cigna will allow reimbursement for these codes by any provider or facility only when billed without any other codes (except where the contract allows it). Specimen collection is not generally paid in addition to other services on the same date of service for the same patient whether billed on the same or different claims by the same provider. This guidance applies to all providers, including laboratories. Specimen collection will only be reimbursed in addition to other services when it is billed by an independent laboratory for travel to a skilled nursing facility (place of service 31), nursing facility (place of service 32), or to an individuals home (place of service 12) to collect the specimen.

Please note that if the only service rendered is a specimen collection and/or testing, and all of the required components for an evaluation and management (E/M) service code are not met, then only the code for the specimen collection or testing should be billed. This includes when done by any provider at any site, including an emergency room, free-standing emergency room, urgent care center, other outpatient setting, physicians office, etc.

Q: How does Cigna reimburse specimen collection centers that are outside of a typical office or facility (e.g., "drive thru" testing sites)?

Specimen collection centers like these can also bill codes G2023 or G2024 following the preceding guidance.

Q: Is prior-authorization required for COVID-19 testing?

No. Prior authorization is not required for COVID-19 testing.

Q: What is a serology test?

A serology test is a blood test that measures antibodies. If antibodies are present, it means that individual previously had a specific viral or bacterial infection - like COVID-19.

Q: How is a serology test different from other tests for COVID-19?

There are two primary types of tests for COVID-19:

• Diagnostic tests, which indicate if the individual carries the virus and can infect others
• Serology (i.e., antibody) tests, which indicate if the individual had a previous infection and has now potentially developed an immune response

Q: Does Cigna cover serology tests?

A serology (i.e., antibody) test for COVID-19 is considered diagnostic and covered without cost-share through at least May 11, 2023 when ALL of the following criteria are met:

• An individual seeks and receives a COVID-19 diagnostic test from a licensed or authorized health care provider; or
• A licensed or authorized health care provider refers an individual for a COVID-19 diagnostic test; and
• The laboratory test is FDA approved or cleared or has received Emergency Use Authorization (EUA); and
• The test is run in a laboratory, office, urgent care center, emergency room, or other setting with the appropriate CLIA certification (or waiver), as described in the EUA IFU; and
• The results of a molecular or antigen test are non-diagnostic for COVID-19 and the results of the antibody test will be used to aid in the diagnosis of a condition related to COVID-19 antibodies (e.g., Multisystem Inflammatory Syndrome); and
• The laboratory or provider bills using the codes in our interim billing guidelines and testing coverage policy.

Q: How much will Cigna reimburse for covered diagnostic COVID-19 serology testing?

When specific contracted rates are in place for diagnostic COVID-19 serology tests, Cigna will reimburse covered services at those contracted rates. When no contracted rates are in place, Cigna will reimburse covered diagnostic serology laboratory tests consistent with CMS reimbursement, including $42.13 for code 86769 and $45.23 for code 86328, to ensure consistent, timely, and reasonable reimbursement.

Q: Will Cigna waive customer cost-sharing requirements for services related to COVID-19?

Yes. Cigna will waive all customer cost-share for diagnostic services, testing, and treatment related to COVID-19, as follows:

The visit will be covered without customer cost-share if the provider determines that the visit was consistent with COVID-19 diagnostic purposes. The provider will need to code appropriately to indicate COVID-19 related services.

Please note that cost-share still applies for all non-COVID-19 related services.

Q: How should providers bill for post COVID-19 treatments?

The ICD-10 code that represents the primary reason for the encounter must be billed in the primary position. When the condition being billed is a post-COVID condition, please submit claims using ICD-10 code U09.9.

Q: Does Cigna cover Remdesivir in inpatient and outpatient settings?

Yes. Cigna covers Remdesivir for the treatment of COVID-19 when administered in inpatient or outpatient settings consistent with EUA usage guidelines and Cigna's Drug and Biologic Coverage Policy.

Q: Is prior authorization required when administering Remdesivir for COVID-19 treatment?

No.

Q: How should Remdesivir be billed when administered in an outpatient setting?

Following the recent statement from the National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel indicating that a three-dose regimen of Remdesivir in the outpatient setting can be effective in preventing progression to severe COVID-19, CMS created HCPCS code J0248 when administering Remdesivir in an outpatient setting. Providers should bill this code for dates of service on or after December 23, 2021.

Q: How does Cigna reimburse Remdesivir?

Cigna will reimburse Remdesivir for COVID-19 treatment when administered in inpatient or outpatient settings at the national CMS reimbursement rate (or average wholesale pricing [AWP] if a CMS rate is not available) when the drug costs are not included in case rates or per diems to ensure timely, consistent, and reasonable reimbursement. Standard customer cost-share applies.

Q: Does Cigna cover the COVID-19 antiviral treatments Paxlovid and molnupiravir?

Yes. The U.S. Food and Drug Administration (FDA) recently approved for emergency use two prescription medications for the treatment of COVID-19: PaxlovidTM (from Pfizer) and molnupiravir (from Merck).

Coverage information

• All Cigna pharmacy and medical plans will cover Paxlovid and molnupiravir at any pharmacy or doctors office (in- or out-of-network) that has them available.
• All Cigna Customers will pay $0 ingredient cost while funded by government, while Cigna commercial customers will pay up to a $6 dispensing fee when obtained at a pharmacy where the medications are available.
• We are awaiting further billing instructions for providers, as applicable, from CMS.
• Please see Cigna's updated Drug and Biologic Coverage Policy for additional coverage information for molnupiravir (pages 6-7) and Paxlovid (pages 7-9).

Q: Did Cigna offer accelerated credentialing during the COVID-19 pandemic?

Yes. Cigna accelerated its initial credentialing process for COVID-19 related applications through June 30, 2022. As of July 1, 2022, standard credentialing timelines again apply. However, Cigna will still consider requestes for accelerated credentialing on a case-by-case basis.

In addition, Cigna recognizes and expects that providers will continue to follow their usual business practices regarding onboarding new providers, locum tenens, and other providers brought in to cover practices or increase care during times of high demand.

Q: What is Cigna's approach to allow participating providers to deliver in-person or virtual care in a state where they are not licensed or accredited?

Cigna will allow commercial and behavioral providers who are participating with Cigna (and who have up-to-date credentialing) to provide in-person or virtual care in other states to the extent that the scope of the license and state regulations allow such care to take place.

When a state allows an emergent temporary provider licensure, Cigna will allow providers to practice in that state as participating if a provider is already participating with Cigna, is in "good standing," and if state regulations allow such care to take place. While Cigna doesn't require further credentialing or license validation, and the provider can work under the scope of their license, providers are encouraged to inform Cigna when they will practice across state lines.

Informing Cigna prior to delivering services in other states can help to ensure claims are adjudicated correctly when submitted with addresses in states other than the provider's usual location.

Q: Will Cigna reimburse medical students, interns, residents, or fellows in training for care provided to patients during the COVID-19 crisis?

Cigna continues to reimburse participating providers when they are credentialed to practice medicine per state regulations, have a current contract, and have completed the Cigna credentialing process.

Non-participating providers will only be reimbursed if:

• They have a valid license and are providing services within the scope of their license; and
• If the customer has out-of-network benefits or if the services are COVID-19 related

Q: Is Cigna temporarily waiving the authorization requirement for facility-to-facility transfers?

Yes. Cigna commercial and Cigna Medicare Advantage will waive the authorization requirement for facility-to-facility transfers from December 12, 2022 through May 11, 2023.

Important notes

• Cigna will allow direct emergent or urgent transfers from an acute inpatient facility to a second acute inpatient facility, skilled nursing facility (SNF), acute rehabilitation facility (AR), or long-term acute care hospital (LTACH).
• This waiver applies to all patients with a Cigna commercial or Cigna Medicare Advantage benefit plan.
• Routine and non-emergent transfers to a secondary facility continue to require authorization.

What the accepting facility should know and do

• The facility that the patient is being transferred to (e.g., SNF, AR, or LTACH) is responsible for notifying Cigna of admissions the next business day.
• Coverage reviews for appropriate levels of care and medical necessity will still apply.
• Concurrent review will start the next business day with no retrospective denials.
• Per usual policy, Cigna does not require three days of inpatient care prior to transfer to a SNF.
• When a claim is submitted by the facility the patient was transferred to (e.g., SNF, AR, or LTACH), the facility should note that the patient was transferred to them without an authorization in an effort to quickly to free up bed space for the transferring facility.

Q: Will Cigna extend the window for prior authorization approvals?

Yes. Considering the pressure facilities are under, Cigna will extend the authorization approval window from three months to six months on request.

Q: Does Cigna remain staffed to review precertification requests and process and pay claims in a timely manner?

Yes. Cigna remains fully staffed, and is committed to ensuring that precertification requests are reviewed in a timely manner and that there is no interruption of claims processing or claims payments.

Q: Does Cigna cover pre-admission and pre-surgical COVID-19 testing?

Yes. Cigna covers pre-admission and pre-surgical COVID-19 testing with no customer cost-share when performed in an outpatient setting through at least May 11, 2023. Providers should bill the pre-admission or pre-surgical testing of COVID-19 separately from the surgery itself using ICD-10 code Z01.812 in the primary position.

Q: Does Cigna waive cost-share for an entire emergency room, inpatient, or outpatient visit if COVID-19 screening was performed as a secondary procedure?

No. If a patient presents for services other than COVID-19, Cigna will waive cost-share only for the COVID-19 related services (e.g., laboratory test). For example, if a patient presents at an emergency room with a suspected broken ankle after a fall and is also tested for COVID-19 during the visit, Cigna would cover services related to treating the ankle at standard customer cost-share, while the COVID-19 laboratory test would be covered at no customer cost-share.

Q: Is Cigna suspending all denials for failure to secure authorization?

No. Claims for services that require precertification, but for which precertification was not received, will be denied administratively for FTSA. Please note, however, that we consider a providers failure to request an authorization due to COVID-19 an extenuating circumstance in the same way we view care provided during or immediately following a natural catastrophe (e.g., hurricane, tornado, fires, etc.). Therefore, we will not enforce an administrative denial for failure to secure authorization (FTSA)on appeal if an extenuating circumstance due to COVID-19 applied. In such cases, we will review the services provided on appeal for medical necessity to determine appropriate coverage.

As a reminder, precertification is not required for the evaluation, testing, or medically necessary treatment of Cigna customers related to COVID-19.

Q: Has Cigna removed prior authorization requirements for advanced imaging?

No. Cigna continues to require prior authorization reviews for routine advanced imaging. Per usual protocol, emergency and inpatient imaging services do not require prior authorization. Online prior authorization services are available 24/7, and our clinical personnel is available seven days a week, including evenings. Approximately 98% of reviews are completed within two business days of submission. We continue to monitor the COVID-19 outbreak and will change requirements as appropriate. Please note that Cigna temporarily increased the precertification approval window for all elective inpatient and outpatient services - including advanced imaging - from three months to six months for dates of authorization beginning March 25, 2020 through March 31, 2021.

Q: If a facility receives an authorization to perform a procedure for a patient, but then has to refer the patient to another facility for COVID-19 related reasons, does Cigna require a new authorization/precertification request for the other facility?

Through March 31, 2021, if the customer already had an approved authorization request for the service, another precertification request was not needed if the patient is being referred to another similar participating provider that offers the same level of care (e.g., getting a CT scan at another facility within the same or separate facility group). As of April 1, 2021, Cigna resumed standard authorization requirements.

Q: Has Cigna lifted precertification requirements for elective surgeries or admissions?

No. Cigna has not lifted precertification requirements for scheduled surgeries. Precertification (i.e., prior authorization) requirements remain in place. Cigna remains adequately staffed to respond to all new precertification requests for elective procedures within our typical timelines. We will continue to assess the situation and adjust to market needs as necessary.

Further, we will continue to monitor inpatient stays, which helps us to meet customers' clinical needs and support safe discharge planning.

Additionally, Cigna understands the tremendous pressure our health care delivery systems are under and will factor in the current strain on health care systems and incorporate this information into retrospective coverage reviews.

Please note that COVID-19 admissions would be considered emergent admissions and do not require precertification.

Q: Will Cigna lift concurrent review of inpatient hospital services?

Cigna understands the tremendous pressure our healthcare delivery systems are under. COVID-19 admissions would be emergent admissions and do not require prior authorizations. We will continue to monitor inpatient stays. This will help us to meet customers' clinical needs and support safe discharge planning.

Q: Will Cigna allow retrospective reviews for medical necessity of inpatient hospital and emergency services?

Cigna will factor in the current strain on health care systems and will incorporate this information into retrospective reviews.

Q: Does Cigna require prior authorization for home health care services following an inpatient admission?

Cigna does not require prior authorization for home health services.

Q: Is Cigna requiring continued notification requirements pertaining to inpatient admissions?

Hospitals are still required to make their best efforts to notify Cigna of hospital admissions in part to assist with discharge planning. However, facilities will not be penalized financially for failure to notify us of admissions. Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. This is an extenuating circumstance. Ultimately however, care must be medically necessary to be covered.

Q: Will Cigna waive audits of hospital claims payments?

At this time, we are not waiving audit processes, but we will continue to monitor the situation closely.

Q: How is Cigna managing ambulance transport during the COVID-19 pandemic?

• For non-COVID-19 related charges: No changes are being made to coverage for ambulance services; customer cost share will apply. Emergent transport to nearby facilities capable of treating customers is covered without prior authorization. Transport between facilities such as hospitals and SNFs and hospitals and Acute Rehab centers is also covered without prior authorization. Cigna does require prior authorization for fixed wing air ambulance transport.
• For COVID-19 related charges: Customer cost-share will be waived for emergent transport if COVID-19 diagnosis codes are billed.

Q: How is Cigna complying with state mandates related to COVID-19, such as customer cost share waivers, virtual care policies, and testing covered at 100%?

We are actively reviewing all COVID-19 state mandates and will continue to share any changes and more details around coverage, reimbursement, and cost-share as applicable.