Last update: January 24, 2023, 10:15 a.m. CT
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.
Member Coverage and Cost Share: UnitedHealthcare is continuing to extend its temporary cost share (copay, coinsurance or deductible) waiver for COVID-19 telehealth services, as described below. For non-COVID-19 telehealth services, benefits will be adjudicated in accordance with the member’s health plan, as applicable.
From Feb. 4, 2020 through the national public health emergency period (currently scheduled to end April 10, 2023), UnitedHealthcare is waiving cost sharing for in-network and out-of-network testing and testing-related telehealth visits.
From Feb. 4, 2020 through Jan. 31, 2020, UnitedHealthcare is waiving cost sharing for in-network and out-of-network telehealth treatment visits.
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.
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.
Remote patient monitoring will be covered according to the member’s benefit plan and UnitedHealthcare’s standard telehealth reimbursement policy.
Member Coverage and Cost Share: UnitedHealthcare is continuing to extend its temporary cost share (copay, coinsurance or deductible) waiver for COVID-19 telehealth services, as described below. 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 10, 2023), UnitedHealthcare is waiving cost sharing for in-network and out-of-network testing and testing-related telehealth visits.
From Feb. 4, 2020 through Dec. 31, 2020, UnitedHealthcare is waiving 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 the member’s benefit plan. Implementation for self-funded customers may vary.
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.
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.