UnitedHealthcare is waiving cost-sharing for COVID-19 treatment; continuing to expand access to telehealth. Learn more.

UnitedHealthcare is waiving...
Skip left navigation

COVID-19 Telehealth

Last update: April 3, 2020, 11:20 a.m. CDT

UnitedHealthcare will reimburse appropriate claims for telehealth services for dates of service through June 18, 2020 under the following codes: 

To help you understand how UnitedHealthcare will reimburse telehealth services during the COVID-19 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 March 18 through June 18, 2020, unless UnitedHealthcare extends the end date.

UnitedHealthcare is temporarily waiving the CMS and state-based originating site restrictions and audio-video requirement, where applicable, for Medicare Advantage, Medicaid and commercial members. Care providers will be able to bill for telehealth services performed using audio-video or audio only communication while a patient is at home.

This change will apply immediately and be effective until June 18, 2020. The reimbursement policy change applies to services provided to members covered by all Medicaid plans.

Expanded Provider Telehealth Access - UnitedHealthcare is waiving the Centers for Medicare and Medicaid’s (CMS) originating site restriction and audio-video requirement for Medicare Advantage, Medicaid and commercial members from March 18, 2020 until June 18, 2020. Eligible care providers can bill for telehealth services performed using 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.

By removing the originating site and audio-video requirement, UnitedHealthcare has broadened access to telehealth services. Telehealth services will be reimbursed, based on national reimbursement determinations, policies and contracted rates, as outlined in a care provider’s participation agreement. You can find a breakdown by network plan at: Provider Telehealth Policies.

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

UnitedHealthcare reimburses telehealth services according to its telehealth reimbursement policies. Depending on whether a claim is for a Medicare Advantage, Medicaid or commercial member, those policies require slightly different modifiers or place of service indicators for a telehealth claim to be reimbursed. These policy changes will allow you to simply bill for telehealth services performed while the patient is at home.

For all UnitedHealthcare commercial plans, any originating site or audio-video requirements that may apply under UnitedHealthcare reimbursement policies are waived, so that telehealth services provided via a real-time 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 and,
  2. Recognized by the American Medical Association (AMA) included in Appendix P of CPT and appended with modifier 95. 

Reimbursable codes can be found embedded in the reimbursement policy at Telehealth and Telemedicine Policy.

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 via a real-time 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 and,
  2. Recognized by the AMA, included in Appendix P of CPT and appended with modifier 95 

Reimbursable codes can be found embedded in the reimbursement policy at Telehealth and Telemedicine Policy.

For all UnitedHealthcare Medicare Advantage plans, including Dual Eligible Special Needs Plans, any originating site or audio-video requirements that may apply under Original Medicare are waived, so that telehealth services provided via a real-time audio-video or audio only communication system can be billed for members at home or another location. All CPT/HCPCS codes, payable as telehealth when billed with Place of Service 02 under Medicare, 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 here: cms.gov.

Additionally, for commercial, Medicare Advantage and some Medicaid plans, UnitedHealthcare already reimburses appropriate claims for several technology-based communication services, including virtual check-ins, which may be done by telephone, and e-visits for established patients.

For commercial, Medicaid and Medicare Advantage members, UnitedHealthcare has waived audio-video requirements and will reimburse telehealth services provided through live, interactive audio-visual or audio-only transmission to new or existing patients whose medical benefit plans cover telehealth services, unless otherwise permitted by state law. For additional information, visit: Provider Telehealth Policies.

Please note: UnitedHealthcare will reimburse physical, occupational and speech therapy telehealth services provided by qualified health care professionals only when rendered using interactive audio/video technology.

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 

For our commercial and Medicare members, we are following CMS standards for technology. The 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 current nationwide 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 nationwide public health emergency.
  • 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 Medicare or commercial telehealth services during the COVID-19 public health emergency.

For more information, see CMS FAQs.

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

Referrals

Referrals are not required for primary care visits for any of our plans. Some plans may have referral requirements for specialists as before.

We’re listening.

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. 

Submit Feedback

CPT® is a registered trademark of the American Medical Association

Disclaimer:

The benefits described on this website describe federal requirements and UnitedHealthcare national policy. Additional benefits may be available in some states and under some plans.