Last update: April 5, 2023, 3:30 p.m. CT
UnitedHealthcare will reimburse appropriate claims for telehealth services in accordance with the member’s benefit plan. Depending on whether a claim is for a Medicare Advantage, Medicaid, self-funded Group Market health plan, or Individual and fully insured Group Market health plan member, those policies may require different modifiers, date of service limitations or place of service indicators for a telehealth claim to be reimbursed.
Please review each network plan section below for specific plan details. You can use our Eligibility and Benefits self-service to verify member eligibility, help determine telehealth coverage, view care plans and get digital ID cards. You can also call the number on the back of the member’s ID card for more information.
Originating Site Expansion
For certain markets and plans, UnitedHealthcare is continuing its expansion of telehealth access, including temporarily waiving the Centers for Medicare & Medicaid Services (CMS) originating site requirements.
Additional telehealth information may vary by network plan, so please review each section below for details.
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.
Audio-Only: In accordance with CMS fee schedule changes for audio-only codes, providers will continue to be reimbursed for audio-only visits at the rate they would receive for audio-video or in-person codes. CMS rates for audio-only telephonic evaluation and management (E/M) codes, as well as virtual check-ins (which may be done by telephone) and e-visits for established patients for dates of service on or after March 1, 2020.
Audio-only visits and other services not requiring video technology include:
Please note that Medicare Advantage provider and member incentive programs will not include encounters that are audio only and will require telehealth visits that use live, interactive audio and visual elements.
Member Coverage and Cost Share: UnitedHealthcare Medicare Advantage will continue to extend its temporary cost share waiver (copay, coinsurance or deductible) for certain telehealth services, as described below:
Originating Site Expansion: For all UnitedHealthcare Medicaid plans, any originating site or audio-video requirements under UnitedHealthcare reimbursement policies are waived if consistent with state-specific regulations and/or guidance, so 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. For PT/OT/ST, chiropractic therapy, home health and hospice provider visits, interactive audio-video technology must be used.
Reimbursement: UnitedHealthcare Community Plan will reimburse telehealth services that are:
A list of reimbursable codes that can be used during the COVID-19 national public health emergency period can be found under the Billing Guidance section below. You can also check your state-specific website for guidance.
Member Coverage and Cost Share: UnitedHealthcare Medicaid will adhere to state-specific cost share regulations for in-network telehealth services for medical, outpatient behavioral, PT/OT/ST, chiropractic therapy, home health, hospice and remote patient monitoring.
Medicaid state-specific requirements and time periods may vary. Medicaid state-specific rules 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’s specific UnitedHealthcare Community Plan website.
Referrals: Referrals are not required for primary care visits for any of our plans. However, some plans may have referral requirements for specialists that were in place before the national public health emergency period. You can use our Referrals feature on the on the UnitedHealthcare Provider Portal to submit and check member referrals for all benefit plans.
Updated Telehealth Reimbursement Policy
In 2020 during the national public health emergency period, UnitedHealthcare expanded coverage for certain telehealth services. This expanded coverage included adding additional services eligible for coverage, and allowing reimbursement for those services, including when they were rendered within our members’ homes. This helped us better align with the Centers for Medicare & Medicaid Services’ (CMS) temporary waiving of originating site requirements.
Beginning Jan. 1, 2021, UnitedHealthcare has updated and expanded our Telehealth Reimbursement Policy to similarly expand the list of telehealth services eligible for reimbursement and continue to allow home as an originating site.
Originating Site Expansion: For all UnitedHealthcare Individual and fully insured Group Market health plans, we are continuing to allow a 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 at a CMS originating site. Specifically:
COVID-19 Visits
Non-COVID-19 Visits
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.
Member Coverage and Cost Share: UnitedHealthcare Individual and fully insured Group Market health plans will continue to extend its temporary cost share (copay, coinsurance or deductible) waiver for certain telehealth services, as described below. The following cost-share waiver information applies to COVID-19 visits for medical, outpatient behavioral, PT/OT/ST, home health, hospice and remote patient monitoring, with opt-in available for self-funded employers. Benefits will be adjudicated in accordance with the member’s health plan, if applicable.
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. Coverage for out-of-network services is determined by the member’s benefit plan. Implementation for self-funded customers may vary.
As of Oct. 1, 2020, benefits are adjudicated in accordance with the member’s benefit plan.
Updated Telehealth Reimbursement Policy
In 2020 during the national public health emergency period, UnitedHealthcare expanded coverage for certain telehealth services. This expanded coverage included adding additional services eligible for coverage and allowing reimbursement for those services, including when they were rendered within our members’ homes. This helped UnitedHealthcare better align with the Centers for Medicare & Medicaid Services’ (CMS) temporary waiving of originating site requirements.
Beginning Jan. 1, 2021 UnitedHealthcare has updated and expanded our Telehealth Reimbursement Policy to similarly expand the list of telehealth services eligible for reimbursement and continue to allow home as an originating site.
Originating Site Expansion: For self-funded 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. Specifically:
COVID-19 Visits
Non-COVID-19 Visits
Member Coverage and Cost Share: 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.
Referrals: Referrals are not required for primary care visits for any of our plans. However, some plans may have referral requirements for specialists that were in place before the national public health emergency period. You can use our Referrals to submit and check member referrals for all benefit plans.
UnitedHealthcare generally follows CMS policies on the types of care providers eligible to deliver telehealth services, although individual states may define eligible care providers differently. These include:
Through Dec. 31, 2020, additional provider types (PT/OT/ST, chiropractic therapy, home health, hospice and remote patient monitoring) may also engage in telehealth services. See specific pages for details. As of Jan. 1, 2021, please see the UnitedHealthcare Commercial Telehealth Reimbursement Policy for eligible care provider types.
Attestation: We will not require attestation, except for with behavioral health services. For more information, visit providerexpress.com.
For our Medicare Advantage, Medicaid, self-funded Group Market health plans, and Individual and fully insured Group Market health plans, we are following 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 communication technologies.
Providers are responsible for providing telehealth services in accordance with OCR’s notice:
For more information, visit cms.gov.
UnitedHealthcare is reimbursing all codes on the CMS Covered Telehealth Services list during the national public health emergency for services furnished under Medicare Advantage, Medicaid* and Individual and fully insured Group Market health plans. UnitedHealthcare is also reimbursing additional codes for Individual and fully insured Group Market health plans through the national public health emergency period. Additional covered codes and information can be found in the Telehealth and Telemedicine Reimbursement policies for Medicaid and Individual and fully insured Group Market health plans.
Telehealth Scenario Examples
To help you understand how UnitedHealthcare is reimbursing telehealth services during the national public health emergency period and beyond, we created a telehealth coding guide that includes scenarios to show some examples of how services might be reimbursed.
UnitedHealthcare’s temporary and/or permanent changes to its reimbursement policies do not alter state and federal laws applicable to your practice.
CPT® is a registered trademark of the American Medical Association
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.