COVID-19 Physical Health, Occupational and Speech Therapy

Last update: October 7, 2020, 5:15 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 apply under Original Medicare are temporarily waived as described below, 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 Dec. 31, 2020. 

From Jan. 1, 2021 through the national public health emergency period (currently scheduled to end Jan. 20, 2021), UnitedHealthcare will cover all in-network and out-of-network telehealth services as outlined in current CMS guidelines. 

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 certain telehealth services:

  • COVID-19 Testing

From Feb. 4, 2020 through the national public health emergency period (currently scheduled to end Jan. 20, 2021), UnitedHealthcare is waiving cost sharing for in-network and out-of-network testing-related telehealth visits. 

  • COVID-19 Treatment 

From Feb. 4, 2020 through Dec. 31, 2020, UnitedHealthcare is waiving cost sharing for in-network and out-of-network telehealth treatment visits.

  • Non-COVID-19 Visits

Through Sept. 30, 2020, UnitedHealthcare extended the cost share waiver for telehealth services for in- and out-of-network providers.

Beginning Oct. 1, 2020, cost sharing for telehealth services will be adjudicated in accordance with the member’s benefit plan.

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 for certain visits, as described below. 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:

COVID-19 Visits 

  • For in-network providers, UnitedHealthcare will extend the expansion of telehealth access for COVID-19 testing and treatment through Dec. 31, 2020. From Jan. 1, 2021 and beyond, UnitedHealthcare will cover all in-network telehealth services as outlined in current CMS guidelines and additional codes as outlined in our telehealth reimbursement policy.
  • For out-of-network providers, UnitedHealthcare will extend the expansion of telehealth access for COVID-19 testing through the national public health emergency period, currently scheduled to end Jan. 20, 2021. 
  • For out-of-network providers, UnitedHealthcare will extend the expansion of telehealth access for COVID-19 treatment through Oct. 22, 2020. As of Oct. 23, 2020, out-of-network telehealth services are covered according to the member’s benefit plan and UnitedHealthcare’s standard telehealth reimbursement policy.

 Non-COVID-19 Visits

  • For in-network providers, UnitedHealthcare will extend the expansion of telehealth access through Dec. 31, 2020. From Jan. 1, 2021, UnitedHealthcare will cover all in-network telehealth services as outlined in current CMS guidelines and additional codes as outlined in our telehealth reimbursement policy.
  • For out-of-network providers, the expansion of telehealth access ended July 24, 2020. As of July 25, 2020, out-of-network telehealth services are covered according to the member’s benefit plan and UnitedHealthcare’s standard telehealth reimbursement policy.

State Provision Exceptions: Please review the Telehealth State Provision Exception page for state-specific telehealth coverage, reimbursement rules, regulations and time limits that apply to Individual and fully insured Group Market health plans (application for self-insured customer benefit plans may vary). These provisions may vary from federal regulations. 

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 COVID-19 PT/OT/ST 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.

  • COVID-19 Testing 

From Feb. 4, 2020 through the national public health emergency period (currently scheduled to end Jan. 20, 2021), UnitedHealthcare is waiving cost sharing for in-network and out-of-network testing-related telehealth visits. 

  • COVID-19 Treatment

From Feb. 4, 2020 through Dec. 31, 2020, UnitedHealthcare is waiving cost sharing for in-network telehealth treatment visits.

Out-of-network cost-share waivers will end Oct. 22, 2020. After that date, coverage for out-of-network services will be determined by the member’s benefit plan. Implementation for self-funded customers may vary.

  • Non-COVID-19 Visits 

For in-network providers, UnitedHealthcare extended 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 will be 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.

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. 

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.