Update: The COVID-19 national emergency and public health emergency (PHE) ended on May 11, 2023. As a result, Evernorth’s cost-share waiver for diagnostic COVID-19 tests and related office visits ends on May 12, 2023.

Individual providers and outpatient clinics may permanently use telehealth for outpatient therapy, applied behavior analysis (ABA)*, medication management, and Employee Assistance Program (EAP) services. The expiration of the PHE does not apply to these telehealth services.

* Medical Necessity Criteria for the level of care being delivered must continue to be met.

 

Individual providers and outpatient clinics

If you are an individual provider or an outpatient clinic, you may permanently use telehealth for outpatient therapy, applied behavior analysis (ABA),* medication management, and Employee Assistance Program (EAP) services. The expiration of the PHE does not apply to the telehealth services noted above.

You may offer telephonic sessions to patients who do not have access to technology to participate in telehealth sessions, as appropriate and in accordance with current legislative guidance. 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 below)
• Place of Service (POS) 02 in Field 24-B (see sample claim form below)

For illustrative purposes only.

Facilities

Facilities can render some or all of their services via telehealth (i.e., PHP, IOP, or services that are offered within an inpatient stay such as attending consultations or family therapy sessions), if appropriate. Providers may offer telephonic sessions to patients who do not have access to technology to participate in telehealth sessions, as appropriate and 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:
  • Appropriate Revenue Code for the service rendered
  • Appropriate CPT^® or Healthcare Common Procedure Coding System (HCPCS) code for the service rendered
  • Modifier 95**
• If routine outpatient services are normally billed on a CMS1500 claim form, the following must be included:
• Modifier 95^** in Field 24-D to specify telehealth (see sample claim above)
• 02 in Place of Service in Field 24-B (see sample claim above)

* 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.

Coronavirus (COVID-19) Resource Center

Additional Resources

Cigna Medicare

Billing guidelines and telehealth

Cigna Dental

Interim Communication to Providers

QualCare Workers Compensation

Interim billing guidance