Remote Patient Monitoring

Last update: October 7, 2020, 5:35 p.m. CDT

UnitedHealthcare follows Centers for Medicare & Medicaid (CMS) guidelines and considers digitally stored data services or remote physiologic monitoring services reported with CPT® codes 99453, 99454, 99457, 99458, 99473, 99474 and 99091 eligible for reimbursement, according to the CMS Physician Fee Schedule.

  • For Medicare Advantage, remote patient monitoring will be covered per Medicare guidelines. 
  • For Individual and Fully Insured Group Market health plans, remote patient monitoring will be covered according to the member’s benefit plan and UnitedHealthcare’s standard telehealth reimbursement policy.
  • For Medicaid plans, UnitedHealthcare will follow each state’s Medicaid guidelines for CPT® codes 99453, 99454, 99457, 99458, 99473, 99474 and 99091. These codes are eligible for reimbursement. 

Member Coverage and Cost Share: UnitedHealthcare is continuing to extend its temporary cost share (copay, coinsurance or deductible) waiver for COVID-19 telehealth services, as described below. For non-COVID-19 telehealth services, benefits will be adjudicated in accordance with the member’s health plan, as applicable. 

  • COVID-19 Testing 

From Feb. 4, 2020 through the national public health emergency period (currently scheduled to end Jan. 20, 2021), UnitedHealthcare is waiving cost sharing for in-network and out-of-network testing-related telehealth visits. 

  • COVID-19 Treatment 

From Feb. 4, 2020 through Dec. 31, 2020, UnitedHealthcare is waiving cost sharing for in-network and out-of-network telehealth treatment visits.

  • Non-COVID-19 Visits

Through Sept. 30, 2020, UnitedHealthcare extended the cost share waiver for telehealth services for in- and out-of-network providers.

Beginning Oct. 1, 2020, cost sharing for telehealth services will be adjudicated in accordance with the member’s benefit plan. 

For COVID-19 and non-COVID-19-related visits, we will adhere to state-specific cost share regulations for remote patient-monitoring services.

Medicaid state-specific requirements and time periods may vary. Medicaid state-specific rules supersede UnitedHealthcare extension guidelines and as of June 18, 2020. If no state guidance was provided, the cost share waiver ended June 18, 2020 and UnitedHealthcare guidelines will apply. We will adjudicate benefits in accordance with the member’s health plan. For more details, please refer to your state-specific website.

Remote patient monitoring will be covered according to the member’s benefit plan and UnitedHealthcare’s standard telehealth reimbursement policy. 

Member Coverage and Cost Share: UnitedHealthcare is continuing to extend its temporary cost share (copay, coinsurance or deductible) waiver for COVID-19 telehealth services, as described below . Review the following cost share waiver information. Benefits will be adjudicated in accordance with the member’s health plan, if applicable. 

  • COVID-19 Testing 

From Feb. 4, 2020 through the national public health emergency period (currently scheduled to end Jan. 20, 2021), UnitedHealthcare is waiving cost sharing for in-network and out-of-network testing-related telehealth visits. 

  • COVID-19 Treatment

From Feb. 4, 2020 through Dec. 31, 2020, UnitedHealthcare is waiving cost sharing for in-network telehealth treatment visits.

Out-of-network cost-share waivers will end Oct. 22, 2020. After that date, coverage for out-of-network services will be determined by the member’s benefit plan. Implementation for self-funded customers may vary.

  • Non-COVID-19 Visits 

For in-network providers, UnitedHealthcare will extend the cost share waiver for telehealth services through Sept. 30, 2020. For out-of-network providers, the cost share waiver for telehealth services does not apply.  

As of Oct. 1, 2020, benefits will be adjudicated in accordance with the member’s benefit plan.

Implementation of these temporary changes for self-funded customers may vary. Depending on a member’s health plan, providers may need to adjust their administrative processes and systems when collecting member cost share (copays, coinsurance and deductibles). To determine if a member has a self-funded plan, please call UnitedHealthcare Provider Services at 877-842-3210.

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. 

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.