Chiropractic Therapy

Last update: May 13, 2021, 11:02 a.m. CT

UnitedHealthcare will temporarily reimburse telehealth services submitted by chiropractors when provided by qualified health care professionals and rendered using interactive audio-video technology for Medicaid and Individual and fully insured Group Market health plan members. Medicare Advantage coverage limitations still apply, as well state laws and regulations. Benefits will be processed in accordance with the member’s plan.

Reimbursable codes are limited to the specific set of codes listed here. UnitedHealthcare will reimburse eligible codes on a CMS 1500 form using the place of service that would have been reported had the services been furnished in person along with a 95 modifier, or on a UB04 form with applicable revenue codes.

Originating Site Expansion

UnitedHealthcare is continuing its expansion of telehealth access, including temporarily waiving the Centers for Medicare & Medicaid Services (CMS) originating site requirements.

Please review each health plan for specific plan details and reimbursement guidance.

Originating Site Expansion: Any originating site requirements that apply under Original Medicare are temporarily waived, so that telehealth services provided through live interactive audio-video can be billed for members at home or another location. UnitedHealthcare will extend the expansion of telehealth access for in-network and out-of-network providers through Dec. 31, 2020.

Member Coverage and Cost Share: UnitedHealthcare will extend its temporary cost share (copay, coinsurance or deductible) waiver for COVID-19 telehealth services through Dec. 31, 2020. For non-COVID-19 telehealth services, benefits are adjudicated in accordance with the member’s health plan, as applicable.

UnitedHealthcare will adhere to state-specific cost share regulations for chiropractic therapy services. Medicaid state-specific requirements and time periods may vary. Medicaid state-specific rules may supersede UnitedHealthcare extension guidelines and protocols as of June 18, 2020. If no state guidance was provided, the cost share waiver ended June 18, 2020, and UnitedHealthcare guidelines will apply. We will adjudicate benefits in accordance with the member’s health plan. For more details, please refer to your state’s specific UnitedHealthcare Community Plan website.

Originating Site Expansion: For all UnitedHealthcare Individual and fully insured Group Market health plans, any originating site or audio-video requirements under UnitedHealthcare reimbursement policies are temporarily waived for certain visits, as described below. This means that telehealth services provided by a live interactive audio-video or audio-only communication system can be billed for members at home or CMS originating site. For:

COVID-19 Visits 

  • For in-network providers, UnitedHealthcare will extend the expansion of telehealth access for COVID-19 testing and treatment through Dec. 31, 2020.
  • For out-of-network providers, UnitedHealthcare extended the expansion of telehealth access for COVID-19 testing and treatment services through Oct. 22, 2020. As of Oct. 23, 2020, out-of-network telehealth services are covered according to the member’s benefit plan and UnitedHealthcare’s standard telehealth reimbursement policy. 

Non-COVID-19 Visits

  • For in-network providers, UnitedHealthcare will extend the expansion of telehealth access through Dec. 31, 2020.
  • For out-of-network providers, the expansion of telehealth access ended July 24, 2020. As of July 25, 2020, out-of-network telehealth services are covered according to the member’s benefit plan and UnitedHealthcare’s standard telehealth reimbursement policy.

Member Coverage and Cost Share: UnitedHealthcare will extend its temporary cost share (copay, coinsurance or deductible) waiver for COVID-19 telehealth services through Dec. 31, 2020. For non-COVID-19 telehealth services, benefits are adjudicated in accordance with the member’s health plan, as applicable.

Implementation of these temporary changes for self-funded customers may vary. Depending on a member’s health plan, providers may need to adjust their administrative processes and systems when collecting member cost share (copays, coinsurance and deductibles). To determine if a member has a self-funded plan, please call UnitedHealthcare Provider Services at 877-842-3210.

All visits must be performed using live interactive video-conferencing that involves the presence of both parties at the same time and a communication link between them that allows a real-time audio and visual interaction to take place.

E-mailing “stored” exercise videos and discussing or reviewing by phone is not reimbursable.

For Individual and fully insured Group Market health plan members, UnitedHealthcare follows CMS standards for technology. The U.S. Department of Health and Human Services Office for Civil Rights (OCR) is exercising enforcement discretion and waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies.

Providers are responsible to provide telehealth services in accordance with state law and licensing board requirements and OCR’s notice.

Disclaimer:

The benefits and processes described on this website apply pursuant to federal requirements and UnitedHealthcare national policy during the national emergency.  Additional benefits or limitations may apply in some states and under some plans during this time.

We will adjudicate benefits in accordance with the member’s health plan.

Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule.