UnitedHealthcare will reimburse appropriate claims for telehealth services in accordance with the member’s benefit plan. Depending on whether a claim is for a UnitedHealthcare Medicare Advantage, Community Plan or commercial plan member, those policies may have different effective dates and telehealth requirements for a claim to be reimbursed.
Effective with dates of service on and after Jan. 1, 2021, UnitedHealthcare will modify the Telehealth and Telemedicine Policy, including the following:
Eligible telehealth services will only be considered for reimbursement under this policy when reported with place of service (POS) 02. This is consistent with the Centers for Medicare and Medicaid (CMS) billing and reimbursement guidelines. Telehealth claims with any other POS will not be considered eligible for reimbursement.
Modifiers 95, GT, GQ or G0 may be appended to telehealth claims reported with POS 02, but the modifiers will be considered informational and not necessary to identify telehealth services.
UnitedHealthcare will consider the member’s home as an originating site for eligible services.
Various codes will be eligible for consideration under the policy including codes listed in the current policy, as well as similar types of services rendered using interactive audio and video technology.
Certain physical, occupational and speech therapy (PT/OT/ST) telehealth services using interactive audio and video technology will be considered for reimbursement when rendered by qualified health care professionals.
The policy addresses additional provider-member electronic communication including virtual check-ins, remote patient monitoring and E-visits (non-face-to-face, member-initiated communications with providers using online patient portals).
Payment will align with applicable state law.
Telehealth services must be rendered using live, interactive audio and video visits and recognized by:
Centers for Medicare and Medicaid Services (CMS)
American Medical Association (AMA) included in Appendix P of CPT® as telehealth
UnitedHealthcare-identified services which can be effectively performed using telehealth.
CPT® is a registered trademark of the American Medical Association.
Effective Jan. 1, 2021 certain UnitedHealthcare Medicare Advantage plans will allow certain Centers for Medicare & Medicaid (CMS)-eligible telehealth services when billed for members at home. For plans with this telehealth benefit, details will be outlined in the member’s Evidence of Coverage (EOC) and other plan benefit documents.
Outside of the originating site requirements for plans with the additional benefit, we'll follow the current CMS telehealth code list and billing requirements.
For UnitedHealthcare Community Plans, we’ll continue to follow state regulations and guidelines regarding telehealth services and reimbursement. If no state guidance is provided, UnitedHealthcare guidelines will apply, if appropriate.