This policy describes reimbursement for Telehealth and Telemedicine services, which occur when the Physician or Other Qualified Health Care Professional and the patient are not at the same site. Examples of such services are those that are delivered over the phone, via the Internet or using other communication devices. Note: For the purposes of this policy, the terms Telehealth and Telemedicine are used interchangeably.
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Q: How does UnitedHealthcare reimburse for phone calls to patients that are not associated with any other service? For example, a pediatrician receives a call from a mother at 2 A.M. regarding an asthmatic child having difficulty breathing. The physician is able to handle the situation over the phone without requiring the child to be seen in an emergency room. On what basis will the visit be denied?
A: UnitedHealthcare will not reimburse for these services (99441-99443 or 98966-98968), as they are considered included in the overall management of the patient.
Q: A physician makes daily telephone calls to an unstable diabetic patient to check on the status of his condition. These services are in lieu of clinic visits. Will UnitedHealthcare reimburse the physician for these telephone services?
A: No, UnitedHealthcare will not reimburse telephone services (99441-99443 or 98966-98968), as they are considered included in the overall management of the patient.
Q: What is the difference between Telehealth services and telephone calls?
A: Telehealth services are live, interactive audio and visual transmissions of a physician-patient encounter from one site to another using telecommunications technology. They may include transmissions of real-time telecommunications or those transmitted by store-and-forward technology. Telephone calls, which are considered audio transmissions, per the CPT definition, are non-face-to-face evaluation and management (E/M) services provided to a patient using the telephone by a Physician or Other Qualified Health Care Professional, who may report evaluation and management services.
Q: If a provider renders the professional component for a diagnostic service, at a Distant Site from the patient, should modifier GT be reported?
A: No. Modifier GT indicates a face-to-face encounter utilizing interactive audio-visual communication technology. Therefore, it is not appropriate to report modifier GT in this scenario since this does not represent a face-to-face encounter. However, use of modifier 26 would be appropriate to designate that the professional component of the diagnostic service was provided. Please refer to the Professional/Technical Component Policy for more information.