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

Yes. For most benefit plans, COVID-19 vaccines remain covered at 100 percent under the preventive benefit (same as the flu shot) when customers go to an in-network provider.

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

On September 11, 2023, six new CPT codes related to new COVID-19 vaccine boosters became effective, and the vaccines are now available at certain pharmacies and providers.

Additionally, 19 existing vaccine and vaccine administration codes that were previously used had their emergency use authorization revoked on September 12, 2023 and should no longer be billed.

Code	Descriptor	Vaccine name and dose	Reimbursement rate	Effective date
90480	ADMN SARSCOV2 VACC 1 DOSE	N/A (administration code)	All COVID-19 vaccines and their administration are reimbursed at contracted rates.	September 11, 2023
91318	SARSCOV2 VAC 3MCG TRS-SUC	Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Yellow Cap)
91319	SARSCV2 VAC 10MCG TRS-SUC IM	Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Blue Cap)
91320	SARSCV2 VAC 30MCG TRS-SUC IM	COMIRNATY (COVID-19 Vaccine, mRNA) 2023-2024 Formula
91321	SARSCOV2 VAC 25 MCG/.25ML IM	Moderna COVID-19 Vaccine 2023-2024 Formula
91322	SARSCOV2 VAC 50 MCG/0.5ML IM	SPIKEVAX 2023-2024 Formula

As of August 1, 2023 dates of service, Cigna reimburses all covered COVID-19 services, including the vaccines and their administration, at contracted rates (subject to applicable law).
Please note that any future covered vaccines, including additional booster shots and pediatric vaccines, will be covered consistent with this guidance.

For additional information about our coverage of the COVID-19 vaccine, please review our Preventive Care Services administrative policy.

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.

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 appropriately waived.

Q: Will Cigna reimburse providers for the vaccine itself?

When a provider purchases the vaccine themselves, as is the case with the fall 2023 vaccines that are now available, those vaccines are reimbursable.
Previous vaccines were offered free of charge to health care providers by the federal government, so Cigna did not reimburse providers for the cost of the vaccine itself. Providers could, 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 was 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 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 as of August 1, 2023 dates of service (subject to applicable law).

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.

General virtual care guidance

Because we believe virtual care has the potential to help providers attract and retain patients, contribute to their ability to provide the right care at the right time, and reduce access barriers, we implemented a Virtual Care Reimbursement Policy for commercial medical services, effective January 1, 2021. This policy ensures that providers can permanently continue to receive coverage for certain virtual care services provided to their patients with Cigna commercial medical coverage independent of the COVID-19 PHE. For additional information about this policy, please review our dedicated provider Virtual Care website page.

Q: Could providers deliver covered virtual care services to patients with commercial medical Cigna coverage at the onset of COVID-19?

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.

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 May 11, 2023 dates of service.As of May 12, 2023 dates of service, standard customer cost-share applies.
• For non-COVID-19 related services (e.g., oncology visit, routine follow-up care): Standard customer cost-share

Q: Did 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: Did Cigna allow physical, occupational, and speech therapists (PT/OT/ST) to provide virtual care as part of its interim guidance?

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,93 or 95 to indicate virtual care for all services.

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. 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.

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.

Q: Are virtual preventive care services reimbursable?

Yes. Virtual preventive care services billed with codes 99381-99387 and 99391-99397 were covered on an interim basis during the PHE, and are now permanently reimbursable as part of our R31 Virtual Care Reimbursemnent Policy as of May 12, 2023.

Q: Did 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 when billed with code S9083?

No. As of May 12, 2023, Cigna no longer reimburses urgent care centers billing virtual care services with code S9083.
Urgent care centers may continue to be reimbursed for virtual care if they:

• Are contracted to bill other codes besides S9083; and
• Follow the reimbursement criteria set forth in our R31 Virtual Care Reimbursement Policy, including billing a code that is on the list of covered services; and
• Include a virtual care modifier (e.g., GT, GQ, FQ, 93 or 95) on the claim.

When virtual services are covered, an urgent care center will be reimbursed their contracted face-to-face rate(s).

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 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).

Further, please note that we expect to permanently reimburse certain services billed on a UB-04 claim form as part of our R31 Virtual Care Reimbursement Policy in the future. Additional information about this update will be communicated before any changes are made.

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,93 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. Therefore, FaceTime, Skype, Zoom, etc. all continue to be appropriate to use at this time.

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, 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 was 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 an applicable codes, along with:

• POS 02; and
• The ICD-10 code that represents the primary condition, symptom, or diagnosis as the purpose of the consult;
• Note that 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 COVID-19 tests administered by a health care provider?

Yes.Cigna covers medically necessary COVID-19 tests when billed consistent with our updated COVID-19 In Vitro Diagnostic Testing coverage policy. Note that standard cost-share applies for all COVID-19 tests as of May 12, 2023.

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

No. Cigna no longer covers these tests as of May 12, 2023.

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.

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

As of August 1, 2023 dates of service, Cigna reimburses all covered COVID-19 services at contracted rates (subject to applicable law).

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 covered individualized COVID-19 diagnostic tests without cost-share through 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 ICD-10 codes Z11.52 and Z11.59?

For dates of service February 26, 2021 through May 11, 2023, codes Z11.52 and Z11.59 were covered for asymptomatic COVID-19 testing without cost-share when billed with an otherwise covered COVID-19 testing code. As of May 12, 2023, Z11.52 and Z11.59 are considered not medically necessary and are therefore not covered. Please review our updated COVID-19: In Vitro Diagnostic Testing coverage policy for additional information.

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: 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, they should bill only the laboratory code.
• When only laboratory testing is performed, laboratory codes like 87635, 87426,or U0002, 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 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 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 only laboratory testing is performed, laboratory codes like 87635, 87426, or U0002, should be billed following our billing guidance.
• 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 code C9803?

Yes. Cigna covered C9803 with no customer cost-share for a hospital outpatient clinic visit specimen collection, including drive-thru tests, through May 11, 2023 dates of service only when billed without any other codes.As of May 12, 2023, this code remains covered, but standard customer cost-share applies. 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).

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?

Through May 11, 2023, Cigna covered diagnostic antibody tests without cost-share when medically necessary (e.g., for a symptomatic individual 21 years old or younger to aid in the diagnosis of suspected multisystem inflammatory syndrome in children [MIS-C]). When used for diagnostic purposes, Cigna covered FDA EUA approved COVID-19 serology tests without cost-share through May 11, 2023 when billed with the appropriate CPT code.

As of May 12, 2023, Cigna will cover antibody testing for Multi-Inflammatory Syndrome and for post-acute sequelae COVID syndrome (DX codes M35.81 and U09.9). All other DX codes will be denied as not medically necessary. For covered antibody tests on and after May 12, 2023, cost-share will apply.
Please note that Cigna does not cover serology tests when used for non-diagnostic purposes (e.g., for surveillance or return-to-work).

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

As of August 1, 2023 dates of service, Cigna reimburses all covered COVID-19 services at contracted rates (subject to applicable law).

Q: What does Cigna reimburse for COVID-19 related services now that the PHE is over?

Throughout the pandemic, we reimbursed providers at contracted rates for COVID-19 related services (e.g., vaccine administration, infusion treatments, and testing) only when provider-specific rates were in place for certain COVID-19 services. When no specific contracted rates were in place, we reimbursed providers for all covered COVID-19 services billed under the medical benefit at the established national Centers for Medicare & Medicaid Services (CMS) rates.

This reimbursement approach was put in place at the onset of the pandemic to ensure that providers received timely, consistent, and reasonable reimbursement.

Please note that beginning with August 1 , 2023 dates of service, we are now reimbursing all participating providers at contracted rates for COVID-19-related services (subject to applicable law).

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

Cigna waived customer cost-share for diagnostic services, testing, and treatment related to COVID-19, as follows:

Service	Cost-share waived through
The initial COVID-19 diagnostic service (virtually, in an office, or at an emergency room, urgent care center, drive thru specimen collection center, or other facility)Note that 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 has to bill appropriately to indicate COVID-19 related services.	May 11, 2023
Specimen collection by a health care provider
Laboratory test (performed by state, hospital, or commercial laboratory; or other provider)
Treatment (treatments that Cigna will cover for COVID-19 are those covered under Medicare or other applicable state regulations)	February 15, 2021

Please note that cost-share has continued to applied 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 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 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: Does Cigna reimburse for the administration of Remdesivir?

Yes. Cigna continues to reimburse Remdesivir for COVID-19 treatment when administered in inpatient or outpatient settings consistent with CMS guidelines and Cigna coverage and reimbursement policies. Standard customer cost-share applies.

Q: Does Cigna cover Evusheld, and is authorization required prior to administering it?

As of January 26, 2023, Evusheld is no longer authorized by the FDA until further notice, and therefore is no longer covered by Cigna for use in the prevention of COVID-19 in certain adults and pediatric individuals.
From December 8, 2021 through January 25, 2023, Cigna covered Evusheld when administered for the prevention of COVID-19 in certain adults and pediatric individuals consistent with FDA EUA guidance and Cigna's Drug and Biologics Coverage Policy. During this time, Cigna did not require prior authorization for the use or administration of Evusheld.

Q: Did Cigna waive customer cost-share for treatment of COVID-19?

Yes. For dates of service February 4, 2020 through February 15, 2021, Cigna covered COVID-19 treatments without customer cost-share. This policy applied to customers in the United States who are covered under Cigna's employer/union sponsored insured group health plans, insured plans for US-based globally mobile individuals, Medicare Advantage, and Individual and Family Plans (IFP). Cigna also administered the waiver for self-insured group health plans and the company encourages widespread participation, although these plans had an opportunity to opt-out of the waiver option or opt-in to extend the waiver past February 15, 2021.

Q: Did the cost-share waiver for COVID-19 treatment end on February 15, 2021 as planned?

Yes, the cost-share waiver for COVID-19 treatment ended on February 15, 2021. Therefore, as of February 16, 2021 dates of service, cost-share applies for any COVID-19 related treatment.

Q: Will Cigna cover COVID-19 treatment without cost-share for treatment that began February 15, 2021 or prior and extended past February 15, 2021 at the same facility?

Yes. Inpatient COVID-19 care that began on or before February 15, 2021, and continued on or after February 16, 2021 at the same facility, will have cost-share waived for the entire course of the facility stay. Please note that certain client exceptions may apply (e.g., clients may opt out of the treatment cost-share waiver or opt-in for an extension of the cost-share waiver).

Q: What treatments did Cigna cover with no cost-share?

Cigna waived cost-share for COVID-19 related treatment, in both inpatient and outpatient settings, through February 15, 2021 dates of service. There may be limited exclusions based on the diagnoses submitted. Please note that some opt-outs for self-funded benefit plans may have applied.

Q: Did Cigna waive cost-share for all in-network facilities? Does that include rehabilitation centers, skilled nursing facilities, etc.?

Yes. Through February 15, 2021, Cigna waived customer cost-share for any approved COVID-19 treatment, no matter the location of the service. Locations may have included hospitals, rehabilitation centers, skilled nursing facilities, temporary hospitals, or any other facility where treatment is generally provided.

Q: Does Cigna cover the administration of EUA-approved infusion treatments?

Yes. Cigna covered the administration and post-administration monitoring of EUA-approved COVID-19 infusion treatments with no customer-cost share for services provided through February 15, 2021. Certain treatment services provided on and after February 16, 2021 remain covered, but with standard customer cost-share.

Q: Should providers bill for the infusion drug itself even when they receive it for free?

Yes. While we will not reimburse the drug itself when a health care provider receives it free of charge, we request that providers bill the drug on the claim using the CMS code for the specific drug (e.g., Q0243 for Casirivimab and Imdevimab), along with a nominal charge (e.g., $.01). This will help with tracking purposes, and ensure timely reimbursement for the administration of the treatment. If a health care provider does purchase the drug, they must submit the claim for the drug with a copy of the invoice.

Q: Does Cigna separately reimburse diluents or other materials used in the administration of infusion treatments?

No. Diluents are not separately reimbursable in addition to the administration code for the infusion.

Q: Is prior authorization required for the administration of these infusions?

No.

Q: How did providers need to bill for COVID-19 treatment to ensure cost-share is waived?

For services provided through February 15, 2021, providers will need to bill consistent with our interim billing guidelines by including the Diagnosis code (Dx) U07.1, J12.82, M35.81, or M35.89 on claims related to the treatment of COVID-19. Please note that as of August 1, 2020, billing B97.29 no longer waives cost-share. Instead U07.1, J12.82, M35.81, or M35.89 must be billed to waive cost-share for treatment of a confirmed COVID-19 diagnoses.

Q: Will providers be reimbursed for the customer cost-share amount that was waived?

Yes. Cigna will reimburse providers the full allowed amount of the claim, including what would have been the customer's cost share.

Q: Does Cigna offer additional reimbursement for personal protective equipment (PPE) and supply-related costs (e.g., CPT code 99072 and S8301) for medical providers?

No. Cigna does not provide additional reimbursement for PPE-related costs, including supplies, materials, and additional staff time (e.g., CPT codes 99072 and S8301), as office visit (E&M) codes include overhead expenses, such as necessary PPE. Separate codes providers may use to bill for supplies are generally considered incidental to the overall primary service and are not reimbursed separately. Contracted providers cannot balance bill customers for non-reimbursable codes.

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

No. Prior authorization (i.e., precertification) is not required for evaluation, testing, or treatment for services related to COVID-19. Treatment is supportive only and focused on symptom relief.

Prior authorization for treatment follows the same protocol as any other illness based on place of service and according to plan coverage. Generally, this means routine office, urgent care, and emergency visits do not require prior authorization.

Q: Is Cigna extending timely filing periods?

Yes. Cigna currently allows for the standard timely filing period plus an additional 365 days through July 10, 2023. As of July 11, 2023, standard timely filing periods apply.

Q: Were referral requirements to see other physicians, specialists, or facilities previously waived?

Primary care physician referrals for specialist office visits were temporarily waived for Individual & Family Plans (IFP) in Illinois and for all SureFit plans through May 31, 2021. Claims were not denied due to lack of referrals for these services during that time. As of June 1, 2021, these plans again require referrals.

For all other IFP plans outside of Illinois, primary care physicians are still encouraged to coordinate care and assist in locating in-network specialists, but the plans no longer have referral requirements as of January 1, 2021.

Please note that HMO and other network referrals remained required through the pandemic, so providers should have continued to follow the normal process that has been in place.

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

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: Did 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?

The authorization waiver for facility-to-facility transfers for customers with a Cigna commercial or Cigna Medicare Advantage benefit plan was in place from December 12, 2022 through May 11, 2023. As of May 12, 2023, facility-to-facility transfers again require authorization.

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

Yes. We extended the authorization approval window from three months to six months during the PHE. To further accommodate providers and our customers, Cigna will permanently extend the authorization approval window to six months as of May 12, 2023.

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 or pre-surgical COVID-19 testing with no customer cost-share through May 11, 2023 when performed in an outpatient setting. Providers should bill the pre-admission or pre-surgical testing of COVID-19 separately from the surgery itself when billed with a covered COVID-19 testing code and using ICD-10 codes like Z01.812 in the primary position. As of May 12, 2023, these services remain covered, but customer cost-share will apply.

Q: Did 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)through May 11, 2023. 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 if an extenuating circumstance applied. Our FTSA policy allows for excusing the need for precertification for emergent, urgent, or situations where there are extenuating circumstances. 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 did Cigna manage ambulance transport throughout COVID-19?

• 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 through May 12, 2023.

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.