July 24, 2020 at 2:00 PM CT

COVID-19 Updates

With the 90-day continuance of the national public health emergency announced by the U.S. Department of Health and Human Services, UnitedHealthcare is extending our temporary COVID-19 measures. Visit our COVID-19 website for full details.  Please also refer to the Summary of COVID-19 Dates by Program and COVID-19 Testing and Treatment Billing Guide for coding and other billing guidance.

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COVID-19 Physical Health, Occupational and Speech Therapy

Last update: July 24, 2020, 2:35 p.m. CDT

UnitedHealthcare will reimburse physical, occupational and speech therapy (PT/OT/ST) telehealth services provided by qualified health care professionals when rendered using interactive audio-video technology.

Reimbursable codes are limited to the specific set of physical, occupational and speech therapy codes listed here. UnitedHealthcare will reimburse eligible codes using the place of service that would have been reported had the services been furnished in person on a CMS 1500 with 95 modifier or 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 may 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- and out-of-network providers through the national public health emergency period. 

Dates are subject to change based on direction from CMS. Codes on the Medicare telehealth list, and additional codes that UnitedHealthcare covers as “telehealth,” require the use of audio-video technology for Medicare Advantage members.

Reimbursement: During this expansion time frame, we will temporarily reimburse providers for telehealth services at their contracted rate for in-person services. UnitedHealthcare will reimburse claims including one of the CPT codes from the telehealth code list, as long as claims are submitted 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 code and a CPT code with a 95 modifier. Please click here to see CPT codes that are accepted under this policy change.  

UnitedHealthcare will not reimburse providers for audio-only visits. 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. State law and licensing board requirements apply to all providers’ provision of physical, occupation and speech therapy services through telehealth. 

Member Coverage and Cost Share: UnitedHealthcare is continuing to extend its temporary cost share (copay, coinsurance or deductible) waiver for PT/OT/ST telehealth services. Please review the following cost share waiver information. Benefits will be adjudicated in accordance with the member’s health plan, if applicable.

 

COVID-19

Non-COVID-19

In Network and Out of Network

UnitedHealthcare is waiving cost share through the national public health emergency period for COVID-19 visits.*

UnitedHealthcare is waiving cost share through Sept. 30, 2020 for non-COVID-19 visits.*

*This date is subject to change based on direction from CMS.

UnitedHealthcare will adhere to state-specific cost share regulations for PT/OT/ST 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-specific 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. 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 another location. For:

  • COVID-19 visits

UnitedHealthcare will extend the expansion of telehealth access for in- and out-of-network providers through the national public health emergency period.

  • Non-COVID-19 visits

UnitedHealthcare will extend the expansion of telehealth access for in-network providers through Sept. 30, 2020. For out-of-network providers, the expansion of telehealth access will apply through July 24, 2020. As of July 25, 2020, out-of-network telehealth services will only be covered according to the member’s benefit plan and UnitedHealthcare’s standard telehealth reimbursement policy.

Reimbursement: During this expansion time frame, we will temporarily reimburse providers for telehealth services at their contracted rate for in-person services. UnitedHealthcare will reimburse claims including one of the CPT codes from the telehealth code list, as long as claims are submitted 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 code and a CPT code with a 95 modifier. Please click here to see CPT codes that are accepted under this policy change.

UnitedHealthcare will not reimburse providers for audio-only visits. 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. State law and licensing board requirements apply to all providers’ provision of physical, occupation and speech therapy services through telehealth.

Member Coverage and Cost Share: UnitedHealthcare is continuing to extend its temporary cost share (copay, coinsurance or deductible) waiver for PT/OT/ST telehealth services. Please review the following cost share waiver information. Benefits will be adjudicated in accordance with the member’s health plan, if applicable.

 

COVID-19

Non-COVID-19

In Network

For in-network telehealth services, UnitedHealthcare is waiving cost share through the national public health emergency period for COVID-19 visits.*

For in-network telehealth services, UnitedHealthcare is waiving cost share through Sept. 30, 2020 for non-COVID-19 visits.*

Out of Network

For out-of-network telehealth services, UnitedHealthcare is waiving cost share through the national public health emergency period for COVID-19 visits.

For out-of-network telehealth services, cost share waiver does not apply.

 

*This date is subject to change based on direction from CMS.

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 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 communications technologies.

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

There is no change to utilization management requirements for physical, occupational or speech therapy services. You should continue to comply with these requirements.

We’re listening.

We’re committed to keeping you up to date on COVID-19 – we’re monitoring your inquiries and working hard to answer your questions. Let us know how we’re doing.

We’ll be making daily updates to this site. Be sure to check back often for the latest information. 

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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.