Skip left navigation

Provider Telehealth Policies

Please Note: We are actively working to update our Telehealth policies based on CMS guidance from 3/17.

Last update: March 18, 2020, 11:42 p.m. CDT

Effective immediately, UnitedHealthcare is expanding our policies around telehealth services for our Medicare Advantage, Medicaid and commercial membership, making it even easier for patients to connect with their health care provider.

  • Designated Telehealth Partners - Members can access their existing telehealth benefit offered through one of UnitedHealthcare’s designated partners for free.
  • Expanded Provider Telehealth Access - Effective immediately, for the next 90 days (through June 18, 2020), all eligible in-network medical providers who have the ability and want to connect with their patient through synchronous virtual care (live video-conferencing) can do so. We will waive member cost sharing for COVID-19 related visits.

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.

This change in policy is effective until April 30, 2020, but we may extend that date if necessary and will communicate through all appropriate channels.

This policy change applies to members whose benefit plans cover telehealth services, and will allow those patients to connect with their doctor through audio/video visits.  Member cost sharing and benefit plans apply.

UnitedHealthcare will also reimburse providers for telephone calls to existing patients, as described below.

Until April 30, 2020, UnitedHealthcare will reimburse appropriate claims for telehealth services under the following codes:

For all UnitedHealthcare commercial plans, any originating site requirements that may apply under UnitedHealthcare reimbursement policies are waived so that telehealth services provided via a real-time audio and video communication system can be billed for members at home or another location. UHC will reimburse telehealth services, which 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 Medicaid plans, any originating site requirements that may apply under UnitedHealthcare reimbursement policies are waived so that telehealth services provided via a real-time audio and video communication system can be billed for members at home or another location.  UnitedHealthcare Community Plan will reimburse telehealth services, which 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.  

For all UnitedHealthcare Medicare Advantage plans, including Dual Eligible Special Needs Plans, any originating site requirements that may apply under Original Medicare are waived so that telehealth services provided via a real-time audio and video 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 and the GQ or GT modifiers, as appropriate, under Medicare will be covered on our Medicare Advantage plans for members at home during this time.  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, for established patients.

Until April 30, 2020, UnitedHealthcare will extend this reimbursement to all Medicaid plans.

Virtual Check-In, including Telephone:

Our commercial and Medicare Advantage plans currently reimburse for “virtual check-in” patients to connect with their doctors remotely. These services are for established patients, not related to a medical visit within the previous 7 days and not resulting in a medical visit within the next 24 hours (or soonest appointment available). These services can be billed when furnished through several communication technology modalities, such as telephone (HCPCS code G2012) or captured video or image (HCPCS code G2010).

UnitedHealthcare will also reimburse for patients to communicate with their doctors using online patient portals, using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable.

Effective immediately through April 30, 2020, our Medicaid plans will reimburse for “virtual check-in” patients to connect with their doctors remotely. These services are for established patients, not related to a medical visit within the previous 7 days and not resulting in a medical visit within the next 24 hours (or soonest appointment available). These services can be billed when furnished through several communication technology modalities, such as telephone (HCPCS code G2012) or captured video or image (HCPCS code G2010).

UnitedHealthcare will also reimburse for patients to communicate with their doctors using online patient portals, using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable.