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Remote Patient Monitoring

Last update: August 14, 2020, 12:30 p.m. CDT

UnitedHealthcare follows Centers for Medicare & Medicaid (CMS) guidelines and considers digitally stored data services or remote physiologic monitoring services reported with CPT® codes 99453, 99454, 99457, 99458, 99473, 99474 and 99091 eligible for reimbursement, according to the CMS Physician Fee Schedule.

  • For Medicare Advantage, remote patient monitoring will be covered per Medicare guidelines. 
  • For Individual and Fully Insured Group Market health plans, remote patient monitoring will be covered according to the member’s benefit plan and UnitedHealthcare’s standard telehealth reimbursement policy.
  • For Medicaid plans, UnitedHealthcare will follow each state’s Medicaid guidelines for CPT® codes 99453, 99454, 99457, 99458, 99473, 99474 and 99091. These codes are eligible for reimbursement. 

Member Coverage and Cost Share: UnitedHealthcare is continuing to extend its temporary cost share (copay, coinsurance or deductible) waiver for telehealth services. 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

For COVID-19 visits, UnitedHealthcare is waiving cost share through the national public health emergency period, currently scheduled to end Oct. 22, 2020.

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.

For COVID-19 and non-COVID-19-related visits, we will adhere to state-specific cost share regulations for remote patient-monitoring services.

Medicaid state-specific requirements and time periods may vary. Medicaid state-specific rules supersede UnitedHealthcare extension guidelines and 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.

Member Coverage and Cost Share: UnitedHealthcare is continuing to extend its temporary cost share (copay, coinsurance or deductible) waiver for telehealth services. 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

UnitedHealthcare is waiving cost share through the national public health emergency period (currently scheduled to end Oct. 22, 2020) 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

UnitedHealthcare is waiving cost share through the national public health emergency period (currently scheduled to end Oct. 22, 2020) 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.

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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.