COVID-19 Physical Health, Occupational and Speech Therapy

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 CMS originating site.

UnitedHealthcare will extend the expansion of telehealth access for in-network and out-of-network providers through the end of the national public health emergency period on May 11, 2023.

Reimbursement: During this expansion time frame, we will temporarily reimburse providers for telehealth services at their contracted rate for in-person services. For PT/OT/ST and home health provider visits, interactive audio-video technology must be used.

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 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. 

• COVID-19 Treatment 
  From Feb. 4, 2020 through Jan. 31, 2021, UnitedHealthcare is waiving cost sharing for in-network and out-of-network telehealth COVID-19 treatment visits.

• Non-COVID-19 Visits
  UnitedHealthcare will extend the cost 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.

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, 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. For:

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 reimburse 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 end of the national public health emergency period on May 11, 2023.
• For out-of-network providers, UnitedHealthcare extended 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 in-network telehealth services in accordance with the member’s benefit plan and our Telehealth Reimbursement Policy. During the national public health emergency period, ending on May 11, 2023, additional CMS codes may apply.
• 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: A list of reimbursable codes can be found in the UnitedHealthcare Telehealth Reimbursement Policy. Additional codes that can be used during the COVID-19 national public health emergency period can be found under the Billing Guidance section below.

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 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. 

• COVID-19 Treatment
  
  From Feb. 4, 2020 through Dec. 31, 2020, UnitedHealthcare waived 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 will be determined by 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 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.

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.