Cigna's May Newsletter - Guidance for Therapists
Cigna has released their May Newsletter with important information about #COVID telehealth policies!
Please read the update below.
May 2020 newsletter
COVID-19: Interim guidance for behavioral providers
During this time of heightened awareness of the novel Coronavirus, COVID-19, and its recent classification by the World Health Organization (WHO) as a global pandemic, we want to keep you up to date on how Cigna Behavioral Health is working to help support you and your patients with Cigna coverage.
Many behavioral providers have contacted us about delivering telehealth sessions. While we have been reimbursing for telehealth since 2017, we have made some temporary revisions to telehealth requirements, and to other guidelines, to support continuity of care during this unique situation. The following changes are effective March 17, 2020 through July 31, 2020 (unless otherwise noted).
Please note: We are reviewing all new regulations as quickly as possible and will continue to revise the guidance below, as necessary.
Coverage of behavioral telehealth sessions
Behavioral telehealth sessions are available to patients with Cigna coverage and are administered in accordance with their behavioral health benefits. Prior to rendering services, you should verify behavioral health benefits and eligibility for all plan types, including services administered by a third-party administrator, by calling the number on the back of the patient’s ID card. An “S” identifier on the bottom left of the card can help you identify which of your patients have services administered by a third-party administrator.
Expectations for providing telehealth sessions
As a general requirement, Cigna-participating outpatient providers must complete an attestation to deliver telehealth sessions. During this interim period, however, telehealth attestations are not required.
While telephonic sessions are not typically covered in accordance with our Medical Necessity Criteria, we are making an exception during this interim period. You may provide telephonic sessions to patients who do not have access to technology to participate in telehealth sessions, as appropriate.
Best practice standards indicate that providers be licensed in the state(s) where they practice and where their patient is located at the time of service. During this interim period, we understand that special considerations may need to be made, as some individuals may be displaced. We are aware that state-specific licensing requirements for the delivery of telehealth may be waived and/or loosened during this time. You are required to follow federal and/or state guidance as it evolves for the delivery of telehealth. If you have questions about licensing mandates, please contact the appropriate state licensing board(s).
Behavioral providers who meet telehealth requirements (see above) may deliver services via telehealth with no additional credentialing.
Individual providers and outpatient clinics
If you are an individual provider or an outpatient clinic, you may use telehealth for outpatient therapy, applied behavior analysis (ABA),* medication management, and Employee Assistance Program (EAP) services. Include the following information on your claim form:
· Appropriate Current Procedural Terminology (CPT®) code in Field 24-D for the service(s) provided
· Modifier 95** in Field 24-D to specify telehealth (see sample claim form below)
· Place of Service (POS) 02 in Field 24-B (see sample claim form below)
For illustrative purposes only.
During this interim period, facilities can render some or all of their services via telehealth (i.e., intensive outpatient program [IOP], partial hospitalization program [PHP]), if appropriate. Acceptable telehealth formats include virtual sessions via video or telephone (in accordance with current legislative guidance).
· If a facility normally bills services on a UB04 claim form, they must include the following on their claim:
· Revenue Code 780
· Appropriate CPT or Healthcare Common Procedure Coding System (HCPCS) code for the service rendered
· Modifier 95**
· If a facility offers services that are excluded from their per diem rate, they should follow this guidance:
· If these services are normally billed on a UB04 claim form, please refer to the bullet point above.
· If these services are normally billed on a CMS1500 claim form, include Modifier 95** in Field 24-D to specify telehealth and 02 in POS in Field 24-B.
· To provide telehealth services during this interim period, facilities do not need to submit an attestation, nor do they need to change their contracts.
· Prior to rendering services, please call the number on back of the patient’s Cigna ID card to verify eligibility and authorization requirements. At this time there are no procedural changes.
· A facility does not need to contact us if telehealth services are being provided to a patient with Cigna coverage who already has an authorization in place. Current authorizations cover telehealth sessions. If a facility has a clinic contract, attestations are not required during this interim period.
Other interim billing guidance for all behavioral providers
Please note: Providers can also use HCPCS code G2012 for a 5-10 minute phone conversation, and Cigna will waive cost-share for the customer. This will allow for quick telephonic consultations, outside the context of evaluation and management (E&M) services, and will offer appropriate reimbursement for this amount of time.
Effective for dates of service through July 31, 2020, Cigna will allow eConsults when billed with CPT codes 99446-99452 for all conditions. Cigna’s claim systems will be able to accurately process claims with these codes as of May 1, 2020. In addition to the applicable CPT code, providers will need to bill with an appropriate ICD-10 code and POS 02 for virtual services. Cost-share will be waived for both COVID-19 and non-COVID-19 eConsults for at least this interim period.
Employee Assistance Program (EAP) session enhancement
Effective March 21, 2020 through September 30, 2020, Cigna is doubling the available number of free sessions any EAP customer can use for stressors and concerns in response to the impact of COVID-19 on daily lives. There is a maximum of 10 total free sessions per issue.
Normally, EAP sessions are available on a per issue basis throughout the year. Through this enhancement, Cigna has made available a second set of sessions (up to a maximum of 10 total) for the same issue. After the first set of EAP sessions is used, a customer may access a second set of sessions, if necessary.
Examples of stressors/concerns may include, but are not limited to:
· Loss of work
· Work demand/transition to work-at home
· Financial worries
· Work/life balance
· Family/marital conflict
· Hospitalization of loved ones
· Anxiety, isolation, and loss of sleep
As a behavioral provider, you, or your patient with Cigna EAP may contact us to request the additional sessions after the first set has been used. At that time, a new case will be opened and another set of sessions will be made available with a new EAP code.
To confirm how many EAP sessions may be available to a customer, or to request an EAP code, call the number on back of the Cigna ID card. If your patient doesn’t have a Cigna ID card, call Provider Services at 800.926.2273.
If you are not a participating provider with Cigna Behavioral Health and would like to be considered for accelerated initial credentialing, please send an email, including your need, to the appropriate Cigna contracting team:
· Individual providers. Complete the Cigna Behavioral Health Provider Application available at the Cigna for Health Care Professionals website (CignaforHCP.com > Resources > Behavioral Resources > Doing Business with Cigna > Credentialing). When you receive your first outreach from Cigna, alert them of your accelerated request.
· Clinics. Email your accelerated request to BehavioralContracting@Cigna.com.
· Facilities. Email your accelerated request to ProviderFacilityRecruitment@Cigna.com.
If you apply for accelerated initial credentialing, you will receive status updates from our contracting team.
· Continue to watch the Cigna for Health Care Professionals website for interim COVID-19 guidance (CignaforHCP.com > Behavioral Resources > Doing Business with Cigna > COVID-19: Interim Guidance).
· For the foreseeable future, the following platform is available, free of charge, to behavioral providers to deliver telehealth sessions:https://www.psychiatryrecruitment.org/articles/telepsychiatry-software-and-covid-19.
· For more information about the delivery of telehealth in relation to COVID-19, visit:https://info.americantelemed.org/covid-19-news-resources.
· For more information about interim guidance for medical (commercial) providers, visit CignaforHCP.com > Resources > Medical Resources > Doing Business with Cigna > Cigna's response to COVID-19.
· If you have questions about administering benefits for patients wtih Cigna coverage, email Behprep@Cigna.com.
* 1 Medical Necessity Criteria for the level of care being delivered must continue to be met.
** The “GT” modifier has been retired by the Centers for Medicare & Medicaid Services (CMS), but it still acceptable on claim forms.