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COVID-19 Reimbursement Guidelines 

Last updated: August 13, 2020

Providers are encouraged to confirm member benefits and coverage provided by their health plan at the time of service due to the rapidly changing situation.

  • Optum will review claims that may be impacted by cost-sharing waivers and reprocess them automatically. The provider will not need to request a claim adjustment or appeal.
  • Due to the rapidly changing environment around patient cost-sharing waivers, providers may want to allow their claim to be fully processed before collecting any patient cost-sharing responsibility.

State and Federal mandates, as well as self-insured customer benefit plan designs, may supersede the guidelines listed below.

Optum has temporarily expanded our policies around telehealth services to make it easier for UnitedHealthcare members to connect with their behavioral health provider during the COVID-19 public health emergency. Optum has waived the Centers for Medicare and Medicaid’s (CMS) originating site restriction and extended the expansion of telehealth access for UnitedHealthcare Medicare Advantage, Medicaid and commercial members in accordance with the timeframes shown below:

Commercial Membership:  This policy change is effective through September 30, 2020 for in-network providers. For out-of-network providers, this policy change was applicable through July 24, 2020.

Medicare Advantage Membership:  This change in policy is effective for in-network and out-of-network providers through the national public health emergency period, currently in effect through October 22, 2020.

Medicaid Membership:  State Medicaid guidance/mandates apply. If no mandate was issued, the expanded policy was applicable through June 17, 2020.

Links to other Health Plan COVID-19 sites can be found here.

Optum will also reimburse providers for telephone calls to patients during these timeframes, as described below:

Virtual (telehealth) Outpatient Office Visit CPT Codes:

Commercial:  For all Optum commercial plans, any telehealth services provided via a real-time audio and video communication system or telephone can be billed for members at home or another location.

Billing Guidelines:  Optum will reimburse telehealth services which use standard CPT codes for outpatient treatment and a GT, GQ or 95 modifier for either a video-enabled virtual visit or a telephonic session, to indicate the visit was conducted remotely.  Non-contracted providers should use the Place of Service code they would have used had the service been furnished in person (for example, Place of Service code 11). Contracted providers can bill with either the POS they would have used had the service been furnished in person or they can use POS 02 and they should bill using the appropriate CPT code as indicated on their fee schedule.  In accordance with CMS guidance, providers should not bill using CPT code(s) for “telephonic therapy.”

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

Billing guidelines: UnitedHealthcare Community Plan will reimburse telehealth services which use standard procedure codes for outpatient treatment, such as CPT/HCPCS codes and Place of Service 02, or state Medicaid telehealth billing requirements if different than using 02, for either a video-enabled virtual visit or a telephonic session, to indicate the visit was conducted remotely.  Contracted providers should bill using the appropriate CPT code as indicated on their fee schedule. 

Medicare Advantage: For all UnitedHealthcare Medicare Advantage and Medicare Part B 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 or telephone can be billed for members at home or another location.

Billing guidelines: UnitedHealthcare will reimburse telehealth services which use standard CPT codes for outpatient treatment.  Applicable claims should be billed with Place of Service 02 and/or GQ or 95 modifier, for either a video-enabled virtual visit or a telephonic session, to indicate the visit was conducted remotely. Contracted providers should bill using the appropriate CPT code as indicated on their fee schedule. 

Important Notice:  If you have previously submitted claims and did NOT follow the above guidelines, you will need to submit corrected claims using the coding instructions above.  For more information on submitting corrected claims, please see Claims Problem Resolution.

COVID-19 Outpatient Telehealth Billing QRG 

IOP/PHP Telehealth Services:

Billing guidelines: Use standard revenue codes and modifier (GT or 95) (or state Medicaid telehealth billing requirements if different) for both video-enabled virtual visits and telephonic sessions to indicate the visit was conducted remotely

Autism/Applied Behavior Analysis Telehealth Services:

Commercial: For all Optum commercial plans, any telehealth services provided via a real-time audio and video communication system can be billed for members at home or another location.

Billing guidelines: Optum will reimburse telehealth services which use standard CPT codes and a GT modifier or a Place of Service of 02 for both video-enabled virtual visits and telephonic sessions to indicate the visit was conducted remotely.

Medicaid: For all UnitedHealthcare Community Plan (Medicaid) plans, any originating site requirements that may apply under Optum 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.

Billing guidelines: UnitedHealthcare Community Plan will reimburse telehealth services which use standard CPT codes and Place of Service 02 or state Medicaid telehealth billing requirements if different than using 02 for both video-enabled virtual visits and telephonic sessions to indicate the visit was conducted remotely.

Medicare Advantage: For all UnitedHealthcare Medicare Advantage and Medicare Part B plans, including dual eligible special needs plans, any originating site requirements that may apply under Original Medicare are waived.

Billing guidelines: UnitedHealthcare will reimburse telehealth services which use standard CPT codes and Place of Service 02 for both video-enabled virtual visits and telephonic sessions to indicate the visit was conducted remotely.

Optum is continually monitoring this situation and if any further modifications to our normal processes are necessary to accommodate individuals impacted by COVID-19 we will communicate immediate updates on Provider Express. For the latest information as this situation evolves, we encourage people to stay informed by visiting the CDC website.

We’re listening.

We are monitoring the inquires we’re receiving on an ongoing basis and working hard to answer your questions. We will be making frequent updates to this page. Please be sure to check back often for the latest information. 

Disclaimer:

The benefits described within this website describe federal requirements and Optum and UnitedHealthcare national policy. Additional benefits may be available in some states and under some plans.