Cigna Teletherapy Place of Service (POS) Codes 02 and 10
Has anyone encountered this issue with Cigna? Our PPO is supposed to cover out of network "virtual office visits" at "60% of reimbursable cost" Sounds simple, right? Cigna seems to have made a loophole, where teletherapy must include a POS modifier 02 (services not in the home). If it's billed POS 10 (services in the home), nothing is covered and the cost can't even be applied to the deductible. It's some holdover from Covid, when Cigna "temporarily" asked providers to code everything at 02. I have one provider who still codes 02 (covered) and another who started billing 10 (not covered). All the information I can find from Cigna is murky and opaque and dishonest. Even their own reps couldn't figure out why POS 10 is not covered. My provider never asked if I was at home or not. Can I petition the provider to change the code, on the basis that they didn't ask? Should I appeal to Cigna on the basis that it was medically necessary to do my teletherapy session at home, rather than doing a teletherapy session across the street, at the library, in my car, etc. (which are all code 02 "outside the home"). Is this worth hiriring an advocate or lawyer? I have already appealed some claims over 6 months ago, and they did not issue a statement about whether the appeal was approved or denied. I keep going around and around and even Cigna's reps can't give me definitive answers. I just want the costs applied to the deductible. I spend hours on chat and phone about this every week, and I'm begging my provider to help me fix the problem, but they refuse to troubleshoot with me. Any advice much appreciated.
submitted by /u/llama829
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