UnitedHealthcare Telehealth Reimbursement Policy

UnitedHealthcare (UHC) has expanded its telehealth coverage to ensure members can receive quality care while staying safe at home. This page summarizes the key elements of the reimbursement policy for providers, including eligibility, billing codes, documentation requirements, and recent updates.

1. Scope of Coverage

UHC reimburses telehealth services that meet the following criteria:

• Delivered via realtime audiovideo technology that meets state licensure requirements.
• Provided by a UHCparticipating provider who is innetwork for the members plan.
• Offered to members residing in a state where telehealth is permitted by law.

1.1 Covered Service Types

The policy includes, but is not limited to:

• Virtual visits for primary care, urgent care, and specialty care.
• Behavioral health counseling (individual, group, and family).
• Remote patient monitoring (RPM) and chronic care management (CCM).
• Teletriage and econsultations between providers.

2. Eligible Provider Types

UHC recognizes the following clinicians for telehealth reimbursement:

• Physicians (MD/DO)
• Physician assistants (PA) and nurse practitioners (NP)
• Clinical psychologists and licensed clinical social workers
• Therapists (physical, occupational, speech)
• Dentists (for limited teleoral health services)

3. Billing & Coding Guidelines

Telehealth services must be billed using the appropriate CPT/HCPCS codes and modifiers. The table below outlines the most common codes:

3.1 Modifier Use

• 95 Synchronous telemedicine service rendered via realtime interactive audiovideo.
• GT Services delivered via interactive audio and video telecommunications system when 95 is not accepted.
• When a service is delivered exclusively via asynchronous technology (econsults, storeandforward), use the appropriate HCPCS code without a telehealth modifier.

4. Documentation Requirements

Accurate documentation is essential for claim acceptance. Providers must include:

1. Patients consent to receive telehealth services.
2. Date, start and end time of the encounter.
3. Technology platform used (e.g., Zoom for Healthcare, Doxy.me) and confirmation that it complies with HIPAA.
4. Location of the patient (home address) and provider (office or virtual site).
5. Clinical justification, assessment, and plan of care as if the visit were in person.
6. Any technical issues that impacted the encounter and how they were resolved.

5. Reimbursement Rates

UHC generally reimburses telehealth services at the same rate as equivalent inperson services (parity). However, rates may vary by plan type (e.g., Commercial, Medicare Advantage, Medicaid). Providers should reference their specific contracted fee schedule.

6. Special Considerations

6.1 OutofState Providers

Providers may bill for telehealth services to patients residing in a different state only if both states grant mutual licensure or if UHCs statespecific policy permits it. Always verify state licensure before rendering care.

6.2 AudioOnly Services

UHC reimburses audioonly telephone visits for select services (e.g., behavioral health) under specific CPT codes (e.g., 9896098962). These are limited to circumstances where video is not feasible and must be documented accordingly.

6.3 Prior Authorization

Most telehealth visits do not require prior authorization, but certain specialty services (e.g., neurology, oncology) may. Check the provider manual for servicespecific rules.

7. Recent Policy Updates (20242025)

• Expanded parity: Effective Jan12025, all UHC commercial plans must apply full parity for videobased telehealth services.
• New RPM codes: Introduction of CPT9945799458 for additional minutes of RPM management.
• COVID19 waivers continued: Audioonly behavioral health visits remain reimbursable through Dec312025.
• Crossstate licensing: UHC now accepts services rendered by providers holding a license in any state where the patient is located, provided state law permits it.

8. How to Submit a Claim

1. Use the appropriate CPT/HCPCS code and modifier.
2. Enter POS code02 for video and 95 for the telehealth modifier.
3. Include the patients location (Home) in the place of service field.
4. Attach any required supporting documentation (consent form, technology verification).
5. Submit electronically through the providers clearinghouse or directly via UHCs portal.

9. Frequently Asked Questions

Q: Can I bill for a telehealth visit if the patient is in a nursing home?

A: Yes, as long as the patients location is documented (e.g., Nursing Facility) and the service meets all other eligibility criteria.

Q: Do I need a separate consent form for telehealth?

A: A documented verbal consent recorded in the encounter note is sufficient for most UHC plans, but written consent may be required for certain states.

Q: What if the video connection fails?

A: If a switch to an audioonly encounter occurs, document the reason and the time spent. Use the appropriate audioonly CPT code if permitted.

10. Resources & Contact Information

• UHC Provider Portal Policies & Guides
• Provider Support Center Phone: 18005551234
• StateSpecific Telehealth Regulations CMS Telehealth Site

Staying uptodate with UnitedHealthcares telehealth reimbursement policy helps ensure that providers receive appropriate compensation while delivering convenient, highquality care to their patients.