Large national payer to change audio-only telehealth policy

One of the nation’s largest private health insurers is changing its reimbursement policy this year for audio-only telehealth, ending some of the flexibility spurred by the COVID-19 pandemic.

For services rendered on or after May 2, UnitedHealthcare (UHC) will reimburse for audio-only telehealth only for codes listed in Appendix T of the 2023 CPT manual. To be eligible for reimbursement, the codes listed in that appendix must also be reported with modifier 93, “Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System.” Procedure codes not found in Appendix T will be ineligible for payment as telehealth with modifier 93 starting May 2.

Like many payers, UHC expanded coverage of audio-only telehealth services due to the COVID-19 Public Health Emergency, which is now set to expire May 11. For instance, the insurer allowed audio-only office visits, codes 99201-99215, for its Medicaid and commercial insurance customers. But those codes are not among the 38 currently listed in Appendix T. Congress recently passed a budget bill instructing Medicare to continue allowing audio-only telehealth through 2024, but the Centers for Medicare & Medicaid Services has not yet said how it will implement it.

— Kent Moore, AAFP Senior Strategist for Physician Payment

Posted on Feb. 7, 2023