May 21, 2020

Mental Health Resources

Health care professionals can access resources from across UnitedHealth Group to help support their mental and physical well-being during the COVID-19 national public health emergency. Learn more.

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Home Health and Hospice Telehealth Services

Last update: May 22, 2020, 6:10 p.m. CDT

Home health and hospice agencies have a responsibility to help ensure that the use of telehealth is clinically appropriate and in accordance with the member’s care plan.

UnitedHealthcare will reimburse services provided by home health agencies when rendered using interactive audio-video technology for Medicare Advantage, Medicaid and Individual and fully insured Group Market health plan members. Coverage limitations still apply, as well as any state laws and regulations. Benefits will be processed in accordance with the member’s plan.

Cost sharing will be waived for in-network telehealth services used with home health services for Medicare Advantage, Medicaid and Individual and fully insured Group Market health plan members, with opt-in available for self-funded employers. This change is effective for dates of service from March 31, 2020, until June 18, 2020, and is subject to extension with additional notice.

Reimbursement

UnitedHealthcare is temporarily expanding Provider Telehealth Access for Medicare Advantage, Medicaid and Individual and fully insured Group Market health plans by permitting home health agencies to bill services performed while a patient is at home through synchronous virtual care (live video-conferencing). This change will apply starting March 31, 2020, and will be effective until June 18, 2020. Benefits will be adjudicated and claims will be processed in accordance with the member’s benefit plan and your participation agreement (if applicable).

UnitedHealthcare is asking you to bill the codes you would bill as if you were in the home performing the service, and include place of service code 12 and modifier 95, as applicable. Non-participating providers should follow Centers for Medicare & Medicaid Services (CMS) guidance on telehealth protocols.

UnitedHealthcare will not reimburse providers for audio-only visits completed over the telephone. All visits must be performed using synchronous virtual care (live video-conferencing) that involves the presence of both parties at the same time and a communication link between them that allows a real-time interaction to take place. Emailing “stored” exercise videos and discussing or reviewing them by phone is not reimbursable. Services must be performed using interactive video connections that transmit information in both directions during the same time period.

UnitedHealthcare will reimburse services provided by hospice agencies for routine home care when rendered using interactive audio-video technology for Medicaid and Individual and fully insured Group Market health plan members. Coverage limitations still apply, as well as any state laws and regulations. Benefits will be processed in accordance with the member’s plan.

Cost sharing will be waived for in-network telehealth services used with hospice services for Medicaid and Individual and fully insured Group Market health plan members, with opt-in available for self-funded employers. This change is effective for dates of service from March 31, 2020, until June 18, 2020, and is subject to extension with additional notice.

Reimbursement

UnitedHealthcare is temporarily expanding Provider Telehealth Access for Medicaid and Individual and fully insured Group Market health plans by permitting hospice agencies to bill services performed while a patient is at home through synchronous virtual care (live video-conferencing). This change will apply starting March 31, 2020, and will be effective until June 18, 2020. Benefits will be adjudicated and claims will be processed in accordance with the member’s benefit plan and your participation agreement (if applicable).

UnitedHealthcare is asking you to bill the codes you would bill as if you were in the home performing the service, and include place of service code 12 and modifier 95, as applicable. Non-participating providers should follow CMS guidance on telehealth protocols.

UnitedHealthcare will not reimburse providers for audio-only visits completed over the telephone. All visits must be performed using synchronous virtual care (live video-conferencing) that involves the presence of both parties at the same time and a communication link between them that allows a real-time interaction to take place. Emailing “stored” exercise videos and discussing or reviewing them by phone is not reimbursable. Services must be performed using interactive video connections that transmit information in both directions during the same time period.

All visits must be performed using live 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. Emailing “stored” exercise videos and discussing or reviewing them by phone is not reimbursable.

For Individual and fully insured Group Market health plan and Medicare 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 communication technologies.

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

To help you understand how UnitedHealthcare will reimburse home health and hospice telehealth services during the COVID-19 national public health emergency period, we created a telehealth coding guide that includes scenarios to show some examples of how services might be reimbursed. UnitedHealthcare’s temporary changes to its reimbursement policies do not alter state and federal laws applicable to your practice. This document applies to home health and hospice dates of service from March 31, 2020, until June 18, 2020, unless UnitedHealthcare extends the end date. 

 


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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.