As the COVID-19 vaccines continue to be distributed across the country, we are committed to ensuring providers have the latest information related to our response to COVID-19. The following information outlines some of the latest updates, including increased vaccine reimbursement, encouraging patient vaccinations, our coverage of COVID-19 tests, and accommodations we continue to make during the public health emergency (PHE) period.
Increased reimbursement for COVID-19 vaccine administration
To align with the recent CMS update to increase reimbursement for COVID-19 vaccine administration, we have also increased our reimbursement for COVID-19 vaccine administration to $40 per dose for claims with dates of service on and after March 15, 2021 when submitted under Cigna commercial medical benefit plans.
For additional information on our coverage and reimbursement of the COVID-19 vaccine, please review our guidelines at-a-glance flyer or visit our updated provider COVID-19 web page at CignaforHCP.com.
Encouraging patients to get vaccinated
Health care providers remain the most trusted source of information for consumers who are hesitant about receiving the vaccine. That’s why we encourage you to proactively educate your patients - especially those who may have vaccine hesitancy or who are at high-risk of severe COVID-19 illness - on the safety, effectiveness, and availability of the vaccine.
To support these conversations with patients, we have created a flyer in English and Spanish that answers key questions patients are likely to have about the COVID-19 vaccines. We encourage you to share these flyers with your patients, as needed.
Updated coverage criteria for COVID-19 testing
In compliance with recent federal agency guidance, Cigna covers individualized COVID-19 diagnostic tests without cost-share through April 20, 2021 for asymptomatic individuals when referred by or administered by a health care provider. Also in alignment with federal guidance, we do not generally cover testing for public health surveillance, employment purposes, or for other purposes not primarily intended for individualized diagnosis or treatment of COVID-19.
For additional information about Cigna's coverage of diagnostic COVID-19 tests, and for a full outline of our coverage criteria, please visit our updated provider COVID-19 web page or review our updated COVID-19 In Vitro Diagnostic Testing coverage policy.
Additional provider accommodations
Since the COVID-19 pandemic began, we have taken important steps to deliver timely accommodations to providers and customers. With this, we have extended our accommodations related to provider credentialing until the end of public health emergency (PHE) period, currently through April 20, 2021.
Additionally, please know that we recently ended our accommodations related to authorizations. As of April 1, 2021, Cigna resumed standard prior authorization timelines and requirements, except where state mandates may apply.
Please note, however, that we consider a provider’s 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.
Get all the latest updates
Thank you again for the quality care you provide and for all that you're doing to help our customers.
We updated our dedicated COVID-19 provider web page on April 6, 2021 to highlight all of these latest updates. We encourage you to visit the site to get these updates and more.