Telehealth services should be coded and billed in accordance with applicable state laws and regulations, UnitedHealthcare requirements, plan type and by using the appropriate coding guidelines.
Coding and Billing Guidance
Documenting and coding telehealth visits
Telehealth visit documentation should include a statement that the service was provided through telehealth, as well as noting the patient and provider locations, and the names and roles of anyone participating in the visit.
Any condition that affects care or influences treatment should be accurately documented and coded to the highest level of specificity during a telehealth visit.
Rules regarding coverage of codes, modifiers and place of service may vary by payer, patient population and regulatory entity. When coding a telehealth visit, it’s important to review all rules and regulations so telehealth encounters can be billed for eligible providers.
To be eligible for payment, a telehealth visit must be conducted by an eligible care provider using secure, real-time, interactive audio and visual technology.
Please continue to review UnitedHealthcare’s telehealth reimbursement policies for each line of business to determine if other forms of technology assisted interactions are reimbursable, such as e-visits and virtual check-ins.
Patient financial responsibility and benefit eligibility
A telehealth visit is treated like an in-person visit when it comes to patient financial responsibility and care provider payment. UnitedHealthcare members are responsible to pay a copayment or coinsurance as they would for an in-office visit.
Because telehealth visits are treated similarly to office visits for both provider payment and patient financial responsibility, practices should confirm patient eligibility the same way they do today (e.g., real-time eligibility check).
Employers have the option to exclude telehealth from their benefit coverage. This selection will be noted under the copay/vendor coverage information or within detailed benefits information when checking eligibility.
Use UnitedHealthcare Eligibility and Benefits 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.
While medical malpractice insurance typically covers the delivery of care through telehealth technology, we encourage care providers to verify specific coverage with their insurers.
Providers should also verify that their medical malpractice insurance extends to beyond state lines to cover telehealth services provided to patients who reside or are traveling across state lines.
Licensure and Regulatory
Just as for in-person visits, all professional staff delivering patient care or consultations through telehealth technologies should be certified or licensed in their applicable specialty or have a level of certification, licensure, education and/or experience in accordance with state and federal laws. Providers should consult their state medical board or the Federation of State Medical Boards to determine the licensure requirements for their state.
Federal and state laws related to telehealth are constantly evolving. It’s important to understand payer reimbursement policies and state parity laws. Each state has a different set of rules and requirements related to telehealth. To stay up to date on the most recent information for your state consult your state Department of Health website or these websites: