July 24, 2020 at 2:00 PM CT

COVID-19 Updates

With the 90-day continuance of the national public health emergency announced by the U.S. Department of Health and Human Services, UnitedHealthcare is extending our temporary COVID-19 measures. Visit our COVID-19 website for full details.  Please also refer to the Summary of COVID-19 Dates by Program and COVID-19 Testing and Treatment Billing Guide for coding and other billing guidance.

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COVID-19 Telehealth

Last update: July 24, 2020, 4:40 p.m. CDT

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 eligibilityLink self-service tool 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 may apply under Original Medicare are temporarily waived, so that telehealth services provided through live interactive audio-video can be billed for members at home or another location. UnitedHealthcare will extend the expansion of telehealth access for in- and out-of-network providers through the national public health emergency period. 

Dates are subject to change based on direction from CMS. Codes on the Medicare telehealth list, and additional codes that UnitedHealthcare covers as “telehealth,” require the use of audio-video technology for Medicare Advantage members. 

All CPT®/HCPCS codes that are payable as telehealth when billed with modifier 95, GT or GQ, as outlined in our Billing Guidance section below, using the same place of service as if the services had been rendered in person, will be covered on our Medicare Advantage plans. Standard plan copays, coinsurance and deductibles will apply. Codes that are payable as telehealth under Medicare Advantage can be found under the Billing Guidance section.

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/STchiropractic therapy 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, are being adjusted retroactively for dates of service on or after March 1, 2020.

Audio-only visits and other services not requiring video technology include:

  • Audio-only (telephone) E/M services (CPT codes 99441-99443)
  • Online digital E/M services/e-visits (CPT codes 99421-99423 and HCPCS codes G2061-G2063)
  • Virtual check-ins (HCPCS codes G2010 and G2012)

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 (copay, coinsurance or deductible) waiver for telehealth services. The following cost share waiver information applies to related visits for medical, outpatient behavioral, PT/OT/ST, chiropractic therapy and home health, with opt-in available for self-funded employers. 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

UnitedHealthcare is waiving cost share through the national public health emergency period for COVID-19 visits.*

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.

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:

  1. Recognized by CMS and appended with modifiers GT or GQ
  2. Recognized by the AMA, included in Appendix P of CPT and appended with modifier 95

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 referralLink tool to submit and check member referrals for all benefit plans.

Originating Site Expansion: For all UnitedHealthcare Individual and fully insured Group Market health plans, any originating site or audio-video requirements under UnitedHealthcare reimbursement policies are temporarily waived. This means 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:

  • COVID-19 visits
    UnitedHealthcare will extend the expansion of telehealth access for  in- and out-of-network providers through the national public health emergency period.
  • Non-COVID-19 visits
    UnitedHealthcare will extend the expansion of telehealth access for in-network providers through Sept. 30, 2020. For out-of-network providers, the expansion of telehealth access will apply through July 24, 2020. As of July 25, 2020, out-of-network telehealth services will only be covered according to the member’s benefit plan and UnitedHealthcare’s standard telehealth reimbursement policy.

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, chiropractic therapy, home health and hospice provider visits, interactive audio-video technology must be used. UnitedHealthcare will reimburse telehealth services that are:

  1. Recognized by CMS and appended with modifiers GT or GQ
  2. Recognized by the AMA, included in Appendix P of CPT and appended with modifier 95

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.

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 telehealth services. The following cost share waiver information applies to related visits for medical, outpatient behavioral, PT/OT/ST, chiropractic therapy, 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.  

 

COVID-19

Non-COVID-19

In Network

For in-network telehealth services, UnitedHealthcare is waiving cost share through the national public health emergency period 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

For out-of-network telehealth services, UnitedHealthcare is waiving cost share through the national public health emergency period 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.

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 referralLink tool to submit and check member referrals for all benefit plans. 

Originating Site Expansion: UnitedHealthcare is continuing its expansion of telehealth access, including temporarily waiving the Centers for Medicare & Medicaid Services (CMS) originating site requirements for telehealth services. This means 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:

  • COVID-19 visits
    UnitedHealthcare will extend the expansion of telehealth access for in- and out-of-network providers through the national public health emergency period.
  • Non-COVID-19 visits
    UnitedHealthcare will extend the expansion of telehealth access for in-network providers through Sept. 30, 2020. For out-of-network providers, the expansion of telehealth access will apply through July 24, 2020. As of July 25, 2020, out-of-network telehealth services will only be covered according to the member’s benefit plan and UnitedHealthcare’s standard telehealth reimbursement policy.

Reimbursement: During this expansion time frame, we will temporarily reimburse providers for telehealth services at their contracted rate for in-person services.

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 referralLink tool to submit and check member referrals for all benefit plans.

As of March 19, 2020, there is no change to the type of care provider who may submit claims for broad telehealth services. 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:

  • Physician
  • Nurse practitioner
  • Physician assistant
  • Nurse-midwife
  • Clinical nurse specialist
  • Registered dietitian or nutrition professional
  • Clinical psychologist
  • Clinical social worker
  • Certified registered nurse anesthetist

Care providers are required to check with the applicable professional licensing boards for guidelines on where they are able to practice during the COVID-19 national public health emergency period.

Additional provider types (PT/OT/ST, chiropractic therapy, home health, hospice and remote patient monitoring) may also engage in telehealth services during this period. See specific pages for details. 

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:

  • The following HIPAA-approved telehealth platforms may be used during the national public health emergency: Popular applications that allow for video chats – including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype – may be utilized to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA rules related to the good faith provision of telehealth during the COVID-19 national public health emergency period.
  • Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.
  • These platforms are NOT approved: Facebook Live, Twitch, Snapchat, TikTok and similar video communication applications are public facing and should not be used in the provision of telehealth to Optum Behavioral Health plan members by covered health care providers.

While the 1135 waiver is in force, care providers may also use telephones that have audio and video capabilities for telehealth services for Medicare or Individual and fully insured Group Market health plan members during the COVID-19 national public health emergency period.

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 to be used for telehealth for Preventive Medicine and Applied Behavior Analysis for Medicaid* and Individual and fully insured Group Market health plans through the national public health emergency period. View codes here. Additional covered codes can be found in the Telehealth and Telemedicine Reimbursement policies for Medicaid and Individual and fully insured Group Market health plans.

*Medicaid state-specific rules for modifiers and place of service apply.

Telehealth Scenario Examples

To help you understand how UnitedHealthcare is reimbursing telehealth services during the national public health emergency period, we created a telehealth coding guide that includes scenarios to show some examples of how services might be reimbursed.

UnitedHealthcare’s temporary changes to its reimbursement policies do not alter state and federal laws applicable to your practice.

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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.