Last update: January 11, 2021, 9:30 a.m. CT
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.
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 CMS originating site.
UnitedHealthcare will extend the expansion of telehealth access for in-network and out-of-network providers through the national public health emergency period, currently scheduled to end April 20, 2021.
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:
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:
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.
From Feb. 4, 2020 through the national public health emergency period (currently scheduled to end April 20, 2021), UnitedHealthcare is waiving cost sharing for in-network and out-of-network testing and testing-related telehealth 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.
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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.