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United Healthcare Telehealth Policy PT and OT

Update: 4/19/2020

UnitedHealthcare will reimburse physical, occupational and speech therapy telehealth services provided by qualified health care professionals when rendered using interactive audio-visual technology for Medicare Advantage, Medicaid, and Individual and fully insured Group Market health plan members. State laws and regulations apply. Benefits will be processed in accordance with the member’s plan.

This change is effective for dates of service from March 18, 2020 until June 18, 2020.

Cost sharing will be waived for in-network telehealth services for PT/OT/ST services for Medicare Advantage, Medicaid, Individual and fully insured Group Market health plan members, with opt-in available for self-funded employers.

Reimbursable codes are limited to the specific set of physical, occupational and speech therapy codes. UnitedHealthcare will reimburse eligible codes on a CMS 1500 form, using the place of service that would have been reported had the services been furnished in person, along with a 95 modifier, or on a UB04 form with revenue code 780.

PT/OT Code List

All visits must be performed using live video-conferencing that involves the presence of both parties at the same time and a communication link between them that allows a real-time audio and visual interaction to take place.

E-mailing “stored” exercise videos and discussing or reviewing by phone is not reimbursable.

For Individual and fully insured Group Market health plan and Medicare members, UnitedHealthcare follows CMS standards for technology. The U.S. Department of Health and Human Services, Office for Civil Rights  (OCR) is exercising enforcement discretion and waiving penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies.



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