Novel Coronavirus (COVID-19)
UnitedHealthcare Closely Monitoring COVID-19
The health of our members and the safety of those who deliver care are our top priorities. We’re taking action and providing resources to support our members and providers during this challenging time.
Last update: March 18, 2020, 11:56 p.m. CDT
Telehealth Care and Services
We are actively working to update our Telehealth policies based on CMS guidance from 3/17. UnitedHealthcare will waive the Centers for Medicare and Medicaid’s (CMS) originating site restriction for Medicare Advantage, Medicaid and commercial members, so that care providers can bill for telehealth services performed while a patient is at home.
Coding and Reimbursement
UnitedHealthcare is monitoring the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS) and other national and local resources to establish and update coding guidelines and reimbursement amounts. *recently updated
UnitedHealthcare has waived member copays, coinsurance and deductibles for COVID-19 testing at approved locations in accordance with CDC guidelines. This applies to Medicare Advantage, Medicaid and fully insured comprehensive commercial medical plans.
3rd button with primary link
Telehealth Services Frequently Asked Questions
In response to the COVID-19 public health emergency, UnitedHealthcare is expanding its telehealth policies effective immediately. We’re closely monitoring national and local updates from the Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS) and other outlets to adjust our policies as needed. We are actively working to update our Telehealth policies based on CMS guidance from 3/17.
UnitedHealthcare is closely monitoring the drug supply chain to determine if any coverage changes are necessary.
Early prescription refills
UnitedHealthcare members can also fill existing prescriptions early (up to a 90-day refill) through direct pharmacy or mail order. Members can call the pharmacy number on their ID card, or speak directly to a pharmacist, in order to get an early refill.
Care providers can connect to the latest Centers for Disease Control and Prevention (CDC) guidance for health professionals, as well as travel advisories from the U.S. State Department. We will continue to add more resources when available.
- UnitedHealthcare Addresses COVID-19
- UnitedHealth Group Press Release – What We’re Doing
- Coronavirus (COVID-19) Safety Tips
- You can find state-specific guidance, when available, at your state’s UnitedHealthcare Community Plan page.
- Telehealth Services Frequently Asked Questions
We are monitoring the inquires we’re receiving on an ongoing basis and working hard to answer your questions. We will be making daily updates to UHCprovider.com/covid19. Be sure to check back often for the latest information.
Yes, UnitedHealthcare will reimburse care providers for COVID-19 testing, as well as cost share for COVID-19 testing related visits, performed at approved locations and following CDC guidelines. Reimbursement will be made for dates of service on or after Feb. 4, 2020 for members enrolled in comprehensive medical plans and Medicare and Medicaid managed care plans. We ask that care providers hold claims for processing until April 1, 2020.
You can find the most up-to-date CPT® COVID-19 codes and descriptions for testing here. The latest information on codes and reimbursement from UnitedHealthcare is available here. We’ll continue to work closely with industry partners like the American Medical Association to align with industry guidance on testing codes, and update our policies accordingly.
As we receive updates from the Centers for Disease Control and Prevention (CDC), local and global organizations and the federal government, we may have to adjust our business practices, processes and policies accordingly. Any changes or updates will be posted on our care provider website as quickly as possible. If you have questions around billing, claims and/or eligibility, you can continue to use our Link self-service tools.
The declaration of a national emergency provides new program flexibility for Medicare, Medicaid and Children’s Health Insurance Program (CHIP). For instance, clinicians licensed in one state can now cross state borders and treat Medicare and Medicaid patients as needed. As we receive updates, we may have to adjust our state-specific business practices, processes and policies accordingly. If that happens, we’ll post updates on our care provider website as quickly as possible.
Coverage for UnitedHealthcare members
UnitedHealthcare is following Centers for Disease Control and Prevention (CDC) guidelines, which states that a health care provider should order the test. Health care providers should work with local and state health departments to coordinate testing. Certain commercial labs who meet U.S. Food and Drug Administration (FDA) guidelines will also be able to perform the test.
Several large retail outlets and drug stores may offer drive-up testing in their parking lots and as long as the location is FDA approved and a member has a health care provider order, it is an acceptable testing center for specimen collection. As with any public health issue, we are working with and following guidance and protocols issued by the CDC, the FDA and state and local health authorities. Changes or updates to our business practices and policies will be posted on our care provider website as quickly as possible.
- For plans without out-of-network benefits (all HMO plans and some POS plans):
UnitedHealthcare does not cover the COVID-19 test from out-of-network care providers. Members should visit their network primary care provider for assistance with this test.
- For plans with out-of-network benefits (some POS plans and all PPO plans):
We encourage members to visit their network primary care provider to receive the COVID-19 test. However, these plans also allow members to visit out-of-network care providers for covered services, including the COVID-19 test.
PFFS members may receive the COVID-19 test from any Medicare-approved care provider who agrees to accept the PFFS plans’ terms and conditions.
Where can I get more information?
For more information on the latest UnitedHealthcare COVID-19 related resources, visit UHCprovider.com/covid19.