May 21, 2020

Mental Health Resources

Health care professionals can access resources from across UnitedHealth Group to help support their mental and physical well-being during the COVID-19 national public health emergency. Learn more.

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COVID-19 Telehealth

Last update: May 22, 2020, 11:30 a.m. CDT

UnitedHealthcare will reimburse appropriate claims for telehealth services for dates of service from March 18, 2020 through June 18, 2020. 

Consistent with CMS requirements, effective immediately for all Medicare Advantage plans, including DSNP plans, we require care providers to bill audio-only telehealth visits using audio-only codes. For more information about this change, please review the Medicare Advantage section below.

To help you understand how UnitedHealthcare will reimburse 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. This document applies to dates of service from March 18, 2020 through June 18, 2020, unless UnitedHealthcare extends the end date.

UnitedHealthcare is allowing all codes on the CMS Covered Telehealth Services list for the national public health emergency period for Medicare Advantage, Medicaid* and Individual and Group Market health plans.

UnitedHealthcare is also allowing additional codes to be used for telehealth for Preventive Medicine and Applied Behavior Analysis for Medicaid* and Individual and Group Market health plans. View codes here.

Additional covered codes can be found in the Telehealth and Telemedicine Reimbursement policies for Medicaid and Individual and Group Market health plans.

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

Expanded Provider Telehealth Access: UnitedHealthcare is waiving the Centers for Medicare & Medicaid Services (CMS) originating site restriction for Medicare Advantage, Medicaid and Individual and Group Market health plan members from March 18, 2020 through June 18, 2020. For Medicare Advantage plans, including DSNP plans, telehealth services require audio-video communication in accordance with CMS requirements, and audio-only services are covered using audio-only codes. For Medicaid and Individual and Group Market health plan members, eligible care providers can bill for telehealth services performed using either interactive audio-video or audio only, except in the cases where we have explicitly denoted the need for interactive audio-video, such as with PT/OT/ST, while a patient is at home.

The reimbursement policy change applies to services provided to members covered by all Medicaid plans.

Telehealth services will be reimbursed based on national reimbursement determinations, policies and contracted rates, as outlined in a care provider’s participation agreement (if applicable). You can find a breakdown by network plan under the Billing Guidance section above.

The policy changes apply to members whose benefit plans cover telehealth services and allow those patients to connect with their doctor through live, interactive audio-video or audio-only visits. (Some of our self-funded customers may not cover provider-based telehealth services under their member benefit plans.) 

UnitedHealthcare reimburses telehealth services according to its telehealth reimbursement policies. Depending on whether a claim is for a Medicare Advantage, Medicaid or Individual and Group Market health plan member, those policies require slightly different modifiers or place of service indicators for a telehealth claim to be reimbursed.

Attestation: We will not require attestation, except for with behavioral health services. For more information, visit providerexpress.com.

Cost sharing will be waived for in-network telehealth services for COVID-19 and non-COVID-19-related visits for medical, outpatient behavioral and PT/OT/ST services from March 31, 2020 through June 18, 2020. This coverage applies to Medicare Advantage, Medicaid and Individual and fully insured Group Market health plan members with opt-in available for self-funded employers.

According to plan benefits, out-of-network providers may also qualify for telehealth. Benefits will be adjudicated in accordance with the member’s health plan, if applicable.

For all UnitedHealthcare Individual and Group Market health plans, any originating site or audio-video requirements that may apply under UnitedHealthcare reimbursement policies are waived as of March 18, 2020 through June 18, 2020, so that telehealth services provided by a live audio-video or audio-only communication system can be billed for members at home or another location. UnitedHealthcare will reimburse telehealth services that are:

  1. Recognized by CMS and appended with modifiers GT or GQ
  2. Recognized by the American Medical Association (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 above.

For all UnitedHealthcare Medicaid plans, any originating site or audio-video requirements that may apply under UnitedHealthcare reimbursement policies are waived, so that telehealth services provided by a live audio-video or audio-only communication system can be billed for members at home or another location. 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 above.

Effective immediately, care providers are required to follow CMS requirements for billing audio-only telehealth visits for Medicare Advantage members using CMS codes designated for audio-only visits. This change only applies for Medicare Advantage members, including DSNP members. Audio-only visits for Medicaid and commercial plan members can still be billed using the same codes as audio-video telehealth visits. 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. We will continue to waive cost sharing for both audio-video telehealth visits and audio-only telehealth visits through June 18, 2020.

In accordance with recent CMS fee schedule changes for audio-only codes, providers will continue to be reimbursed for audio-only visits at a rate very similar to the rate they would receive for audio-video or in-person codes. CMS rates for audio-only evaluation and management (E/M) codes have been 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 require telehealth visits that use live, interactive audio and visual elements.

For all UnitedHealthcare Medicare Advantage plans, including DSNP, any originating site restrictions that may apply under Original Medicare are waived, so that telehealth services provided through live audio-video can be billed for members at home or another location. All CPT/HCPCS codes, payable as telehealth when billed with modifier 95, GT or GQ and 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 above.

Additionally, audio-only telehealth services are also reimbursable in accordance with CMS policy requiring the use of audio-only codes. This includes telephonic evaluation and management, as well as virtual check-ins, which may be done by telephone, and e-visits for established patients. Medicare Advantage provider and member incentive programs will not include encounters that are audio only.

For Medicare Advantage plans, audio-only services must be billed under designated audio-only codes, including audio E/M, e-visit and virtual check-in codes as designated by CMS.

For Individual and Group Market health plans and Medicaid plans, UnitedHealthcare has waived audio-video requirements and will reimburse medical and outpatient behavioral telehealth visits provided through either interactive audio-video or audio only. For PT/OT/ST provider visits, interactive audio-video technology must be used. For more details on PT/OT/ST telehealth, please click here. 

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 Anesthetists

Due to updated legislation, we have also expanded reimbursement for providers as well as physical, occupational, speech and chiropractic therapists for telehealth services. 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.

For our Medicare Advantage, Medicaid, 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 communications technologies.

Providers are responsible to provide telehealth services in accordance with OCR’s notice and may use:

  • HIPAA-approved telehealth technologies
  • The following 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 Group market health plan members during the COVID-19 national public health emergency period.

For more information, visit cms.gov.

 Care providers may conduct a telehealth visit from any private, secure location that will support member privacy.

View the UnitedHealthcare Telehealth Services: Care Provider Coding Guidance for a list of scenarios that include place of service codes. 

Referrals are not required for primary care visits for any of our plans. However, some plans may have referral requirements for specialists as before. You can use our referralLink tool to submit and check member referral for all benefit plans. 

Telehealth services offer safe alternative solutions for providing care and access to your patients in a time when they need it the most. Learn how to get started with telehealth and tips on making the most out of your telehealth experience. The video features Anupam Goel, M.D., Chief Health Information Officer, UnitedHealthcare Clinical Services.

[UnitedHealthcare logo]

[Provider Update: Tips for Using Telehealth to See Your Patients]

[Anupam Goel, M.D.]

The COVID-19 pandemic creates an opportunity for many of us in primary care to adopt telehealth to help manage our patients. Many encounters meeting the criteria for evaluation and management may be eligible for reimbursement by UnitedHealthcare during this emergency period. 

[Chose videoconferencing technology]

To start using telehealth to see your patients, first choose a videoconferencing technology. There is no requirement to integrate the technology into your EMR system. With the recent decision by Health and Human Services to waive enforcement of HIPAA penalties against providers serving their patients in good faith during the crisis, many common, everyday technologies may be acceptable. And just recently, UnitedHealthcare approved audio-only interactions for the same codes that are included within the existing telehealth scope for many services. Check UHCprovider.com and the guidance from Health and Human Services to see what works best for your situation. Don’t forget, physical therapy, occupational therapy and speech therapy require interactive video and audio to be reimbursed.

[Ensure patient health insurance covers telehealth]

Second, make sure the patient’s health insurance covers telehealth visits. This verification may be easier to perform at the end of a face-to-face visit in anticipation of the next visit. During this national emergency, we’re processing benefits according to the member’s plan.

[Schedule appointment]

Third, schedule the appointment in the way that also updates your back-office staff, since they will be submitting the claim after the appointment. Before the appointment, have your staff verify the patient’s ability to use the videoconferencing platform and determine what information you might need to collect from the patient prior to your appointment.  Your staff might do this in a variety of ways, including reaching out to the patient by email or phone.

[Complete visit]

Fourth, complete your visit. When you document the encounter, detail the reason why the visit was conducted via telehealth along with the member’s consent to have the visit using telehealth.

[Submit claim]

Finally, submit the claim with the relevant billing code, place of service and telemedicine modifiers, as appropriate. UnitedHealthcare’s telehealth reimbursement policies during the COVID-19 emergency can be found by going to UHCprovider.com and clicking on the COVID-19 banner at the top of the page.

This is a fast-moving, ever-changing situation for all of us. Please check the relevant Health and Human Services as well as UnitedHealthcare general telehealth and COVID-19-specific websites for the most up-to-date information, including eligible billing codes and modifiers.

[Disclaimer: This is a video intended for informational purposes only and is not intended to provide instructions or legal guidance on telehealth coverage or reimbursement. For further information, please visit www.UHCprovider.com.]

[UnitedHealthcare logo]

uhcprovider.com

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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.