Last update: April 5, 2023, 3:30 p.m. CT
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 is continuing its expansion of telehealth access for certain visits, including temporarily waiving the Centers for Medicare & Medicaid Services (CMS) originating site requirements and temporarily reimbursing claims submitted by home health agencies and hospice facilities for certain services performed using live, interactive video-conferencing while a patient is at home, consistent with the member’s care plan.
Please review each health plan for specific plan details and reimbursement guidance.
*For hospice services, the following information does not apply to Medicare Advantage health plans. Please note, the following is applicable for home health services only.
Originating Site Expansion: Any originating site requirements that apply under Original Medicare are temporarily waived, as described below, so that home health telehealth services provided through live interactive audio-video can be billed for members at home or CMS originating site. UnitedHealthcare will extend the expansion of telehealth access for in- and out-of-network providers through the end of the national public health emergency period on May 11, 2023.
Member Coverage and Cost Share
UnitedHealthcare is continuing to extend its temporary cost share (copay, coinsurance or deductible) waiver for COVID-19 telehealth services, as described below. For non-COVID-19 telehealth services, benefits will be adjudicated in accordance with the member’s health plan, as applicable.
From Feb. 4, 2020, through the end of the national public health emergency period on May 11, 2023, UnitedHealthcare is waiving cost sharing for in-network and out-of-network testing and testing-related telehealth visits.
From Feb. 4, 2020 through Jan. 31, 2021, UnitedHealthcare is waiving cost sharing for in-network and out-of-network COVID-19 telehealth treatment visits.
In 2021, cost sharing for telehealth services will be determined according to the member’s benefit plan. Most of our Medicare Advantage plans have $0 copayments for covered telehealth services in 2021.
For COVID-19 and non-COVID-19-related visits, we will adhere to state-specific cost share regulations for home health and hospice services. We will also adhere to state guidelines and regulations for date expansion, billing and reimbursement. Medicaid state-specific benefits and rules for codes, modifiers and place of service apply.
Medicaid state-specific requirements and time periods may vary. Medicaid state-specific rules 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, we are continuing to allow home as an originating site for audio-video requirements by updating UnitedHealthcare’s Telehealth Reimbursement Policy. This means that telehealth services provided by a live interactive audio-video communication system can be billed for members at home or CMS originating site. Specifically:
COVID-19
Non-COVID-19 Visits
Member Coverage and Cost Share: UnitedHealthcare is continuing to extend its temporary cost share (copay, coinsurance or deductible) waiver for COVID-19 home health and hospice telehealth services, as described below. Please review the following cost share waiver information. Benefits will be adjudicated in accordance with the member’s health plan, if applicable.
From Feb. 4, 2020, through the end of the national public health emergency period on May 11, 2023, UnitedHealthcare is waiving cost sharing for in-network and out-of-network testing and testing-related telehealth visits.
From Feb. 4, 2020 through Dec. 31, 2020, UnitedHealthcare is waiving cost sharing for in-network telehealth treatment visits.
Effective Jan. 1, 2021, UnitedHealthcare updated and expanded our Telehealth Reimbursement Policy so that most UnitedHealthcare benefits plans include telehealth visits with in-network providers. Members will be responsible for any copay, coinsurance or deductible, according to their benefit plan.
Out-of-network cost-share waivers ended Oct. 22, 2020. After that date, coverage for out-of-network services is determined by the member’s benefit plan. Implementation for self-funded customers may vary.
For in-network providers, UnitedHealthcare will extend the cost share waiver for telehealth services through Sept. 30, 2020. For out-of-network providers, the cost share waiver for telehealth services does not apply.
As of Oct. 1, 2020, benefits are adjudicated in accordance with the member’s benefit plan.
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.
For contracted care providers, all home health and hospice telehealth claims should be billed using the code(s) that would be used if you were in the home performing the service; include place of service code 12 and modifier 95, as applicable. Non-contracted 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 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 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 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. 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 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.
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.