UnitedHealthcare Community Plan Reimbursement Policy Update Bulletin: November 2021

Policy title State(s) Policy summary Effective date
Telehealth/Virtual Health Policy, Professional   Arizona, California, Florida, Hawaii, Indiana, Kansas, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Nebraska, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Rhode Island, Texas, Virginia, Washington, Wisconsin
  • Telehealth and Telemedicine Policy, Professional will have its name changed to “Telehealth/Virtual Health, Professional.”
  • In addition, the term virtual health will be added to the policy to encompass all synchronous, asynchronous, and remote physiologic monitoring (RPM) care between health care professionals and patients. This includes telehealth/telemedicine, communication technology-based services (CTBS), e-visits, virtual check-ins, and interprofessional telephone/internet/electronic health record consultations.  
January 1, 2022
Readmission Policy, Facility Nebraska
  •  When a patient is discharged from an acute care hospital and is readmitted as an inpatient to a facility in the same hospital system within the applicable time frame for the same DRG, the Readmission claim will deny.
  • Exception: Planned Readmissions Admission for cancer or chemotherapy treatment as the principal condition Transfusions for chronic anemia Dialysis or similar repetitive treatments Policy does not apply to Critical Access Hospitals (CAH) or Per Diem Hospitals 
January 1, 2022 

Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided. UnitedHealthcare reimbursement policies may use Current Procedural Terminology (CPT®*), Centers for Medicare and Medicaid Services (CMS) or other coding guidelines. References to CPT or other sources are for definitional purposes only and do not imply any right to reimbursement.

Note: The absence of a policy does not automatically indicate or imply coverage. As always, coverage for a health service must be determined in accordance with the member’s benefit plan and any applicable federal or state regulatory requirements..

The complete library of UnitedHealthcare Community Plan Reimbursement Policies is available at > Policies and Protocols > Community Plan Policies > Reimbursement Policies for Community Plan.