Please Note: We are actively working to update our Telehealth policies based on CMS guidance from 3/17. This FAQ answers common questions about the expansion of our telehealth policies. Information is being added frequently. Please check back often for the latest information.
Last update: March 18, 2020, 11:00 p.m. CDT
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.
UnitedHealthcare will reimburse telehealth services delivered to patients in the home for eligible Medicare, Medicaid and comprehensive medical commercial members until April 30, 2020.
For the latest news and guidance on the virus, please visit the CDC website.
Frequently Asked Questions
UnitedHealthcare is temporarily waiving the CMS and state-based originating site restrictions, where applicable, for Medicare Advantage, Medicaid and comprehensive medical commercial members. Care providers will be able to bill for telehealth services performed while a patient is at home. This change will apply immediately and be effective until April 30, 2020. It may be effective longer, if it’s determined necessary.
By removing the originating site 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,1 and allow those patients to connect with their doctor through live, interactive audio and video visits. Member cost sharing and benefit plans apply.
1 Some of our self-funded customers may not cover provider-based telehealth services under their member benefit plans.
This change is to help reduce potential exposure to COVID-19 and make it even easier for members to connect with their health care provider. We encourage members, if they exhibit symptoms of COVID-19, to seek medical care through their primary care physician.
There is no change to the type of care provider who may submit claims for telehealth services. UnitedHealthcare generally follows CMS’s policies on the types of care providers eligible to deliver telehealth services, although individual states may define eligible care providers differently.
- Nurse practitioner
- Physician assistant
- Clinical nurse specialist
- Registered dietitian or nutrition professional
- Clinical psychologist
- Clinical social worker
- Certified Registered Nurse Anesthetists
No. UnitedHealthcare will reimburse both participating and non-participating care providers who submit appropriate telehealth claims according to the terms of applicable member benefit plans.
UnitedHealthcare will reimburse appropriate claims for telehealth services delivered by telephone if delivery is provided through live, interactive audio and visual transmission to existing patients whose medical benefit plans cover telehealth services and as required law. For additional information, visit: Provider Telehealth Policies.
Members may continue to receive telehealth services from UnitedHealthcare’s Virtual Visits providers, and can now also receive telehealth services from their care provider from home through interactive audio and video visits. This also includes urgent care providers. Member cost sharing and benefit plans will still apply, as well as any state or federal requirements regarding licensing or establishment of a doctor-patient relationship.
Yes. The reimbursement policy change applies to services provided to members covered by all Medicaid plans.
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.
You can find specific information about the reimbursement policy changes and related reimbursable codes at: Provider Telehealth Policies.
Where can I get more information?
For more information on the latest UnitedHealthcare COVID-19 related resources, visit UHCprovider.com/covid19.