Cigna institutes new reimbursement policy for virtual care

Cigna, one of the country’s largest private health insurers, has implemented a new virtual care reimbursement policy as of Jan. 1. The policy builds on billing and coding flexibilities spurred by COVID-19. UnitedHealthcare has also changed its telehealth policies recently. 

Cigna’s new policy applies to services provided to commercial medical customers, including those with Individual & Family Plans (Cigna Behavioral Health and Cigna Medicare Advantage customers will continue to have virtual care services covered through their own separate benefit plans). The policy provides continued payment for virtual services that are typically performed in an office setting.

Common services included in the policy include:

• Routine check-ups
• General wellness visits
• New patient exams
• Behavioral assessments

Common codes included in the policy include:

• Outpatient E/M codes for new and established patients (99202-99215)
• Telephone-only E/M codes (99441-99443)
• Annual wellness visit codes (G0438 and G0439)

Payment Requirements

The following general requirements must be met for Cigna to consider paying for a virtual care visit:

• Services must be one of the eligible codes listed in the new virtual care 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. Physicians should instead bill a typical face-to-face place of service (e.g., POS 11) to ensure they receive the same payment rate as they typically get for an in-person visit.
• Except for the specific phone-only codes, services must be interactive and use both audio and video internet-based technologies (i.e., synchronous communication).

— Brennan Cantrell, Commercial Health Insurance Strategist, American Academy of Family Physicians