With the COVID-19 public health emergency now set to end Jan. 20, Cigna has extended some of its waivers and other COVID-19 exceptions, and introduced some payment changes.
For an overview of waiver dates from Cigna and other major payers, see TMA’s Waiver Dates Chart.
Effective now (as of Nov. 1): Screening payment change
Cigna will not cover ICD-10 code Z11.59 (asymptomatic screening) when billed alone. It may be covered when billed with a diagnosis code that reflects active signs and or symptoms of infection or disease. Cigna will consider coverage of other appropriate codes for asymptomatic testing, including Z03.818 and Z20.828, when medically necessary as described its COVID-19: In Vitro Diagnostic Testing policy.
Extended through Dec. 31: COVID-19 waivers and guidelines
- Cost-share waiver for COVID-19-related treatment, including a virtual treatment visit for a confirmed case.
- Other interim accommodations (such as for credentialing and authorizations) as outlined in the Frequently Asked Questions (FAQ) section of this Cigna page.
- Interim COVID-19 virtual care guidelines as outlined on this Cigna page (see “General Virtual Care Guidelines” in the interim billing guidelines section and “Virtual care services” in the FAQ section).
- Technology requirements for virtual care are waived. For example, phone, video, FaceTime, Skype, and others are appropriate to use.
Extended through Jan. 21, 2021: COVID-19 waivers and eConsults
- Cost-share waiver for COVID-19 diagnostic testing and related office visits, including virtual services.
- Cost-share waiver for related diagnostic tests (other than COVID-19) when billed with the appropriate ICD-10 code and modifier CS.
- Cost-share waiver for a five- to 10-minute phone conversation (virtual screening, COVD-19 or non-COVID-19) billed with code G2012.
- Cost-share waiver for specimen collection.
- Cost-share waiver for testing after suspected or likely exposure.
- eConsults when billed with codes 99446-99449, 99451, and 99452 for all conditions.
- Cost-share waiver for Food and Drug Administration emergency use authorization-approved lab tests when billed by labs using high-throughput technologies as described by the Centers for Medicare & Medicaid Services, using codes U0003 and U0004.
Cigna does not provide additional payment for costs related to personal protective equipment (PPE) – including supplies, materials, and additional staff time (e.g., CPT code 99072) – because evaluation and management (E&M) codes include overhead expenses, including PPE. Codes billed for supplies are generally considered incidental to the overall primary service.
New on Jan. 1: New virtual care policy
Cigna will adopt a new virtual care payment policy for its commercial plans, including individual and family plans. The policy allows payment for routine check-ups, general wellness visits, new patient exams, and behavioral assessments, including for these common codes:
- Outpatient E&M codes for new and established patients (99202-99215);
- Physical and occupational therapy E&M codes (97161-97168);
- Telephone-only E&M codes (99441-99443); and
- Annual wellness visit codes (G0438 and G0439).
Cigna behavioral health and Cigna Medicare Advantage patients continue to have covered virtual care services through their own separate benefit plans.
Last Updated On
November 10, 2020