Wiki Telephonic Cigna/Covid billing help

[TLC]

Hello,
Does anybody know how to bill for the Telephone visit or Video visit for Cigna. We are going back and forth with what to do. Or any other insurances for that sake. We do it one way and then get something back from the insurance they want it another way. Thank you.

 

[SharonCollachi]

I think you're going to have to give us more specific information on what the doctor performed, what you billed, and what the insurance company did.

 

[TLC]

Ok, Visit telephonic 15min we had billed 99442 pt asking if possible Covid. provider says not in the realm of Covid. Some had been billed with POS 11 and some with POS 02. So I need to know what the correct POS would be and they tell us it needs mod GQ.

 

[lbortzfield]

I am in Internal medicine practice in NC. We are billing E/M codes with GQ modifier and POS 11. They are all being paid.

 

[rcj0401]

I am with an FQHC. We billed G2012 for a telephonic check in only, regular POS and GT modifier and they paid. Now, this was one of the first, early out the gate, before all the information came. I don't know that it would still work; we may have just gotten lucky.

 

[Stefanie]

https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html

 

[TLC]

Thank you all for your input

 

[csperoni]

Let me just add that each carrier is different.
CMS came out with official guidelines, then modified them. Some carriers are following whatever CMS policy is, but some (like Cigna), created their own. The most significant difference from Cigna and CMS (and most other carriers) is that Cigna will allow a telephone (audio only) visit to be billed E/M, and will not cover 99441-99443. CMS and most other carriers have specified that audio only is 99441-99443 and to bill E/M requires interactive video.
CMS and most carriers want POS 11 for both telehealth E/M and for telephone 99441-99443. Some carriers still want POS 02 for telehealth E/M.
Modifiers also differ by carrier.

 

[vanessamoldovan]

Ok, Visit telephonic 15min we had billed 99442 pt asking if possible Covid. provider says not in the realm of Covid. Some had been billed with POS 11 and some with POS 02. So I need to know what the correct POS would be and they tell us it needs mod GQ.

Please review the guidelines for modifier GQ. It is not for live two-way communication. It is for one-way, non-live, such as email or messaging.

 

[trarut]

Under Resources on the Cigna site is "Cigna's Response to COVID-19". (The chart posted by Stefanie above is also from that page/document.) This is from their interim billing guidance on that page:

• Providers should bill using a face-to-face code, append the GQ, GT or 95 modifier, and use the POS that would be typically billed if the service was delivered face to face (e.g., POS 11).

https://static.cigna.com/assets/chcp/resourceLibrary/medicalResourcesList/medicalDoingBusinessWithCigna/medicalDbwcCOVID-19.html