UnitedHealthcare modifies telehealth reimbursement policy for 2021

One of the nation’s largest insurers is changing its telehealth reimbursement policy this year. As of Jan. 1, UnitedHealthcare (UHC) has made the following changes to its commercial plans:

• Eligible telehealth services will only be considered for payment when reported with place of service (POS) code 02. Telehealth claims with any other POS code will not be eligible for payment.
• Modifiers 95, GT, GQ or G0 may be appended to telehealth claims reported with POS 02, but the modifiers will be considered informational and not necessary to identify telehealth services.
• UHC will consider the patient’s home an originating site for eligible services.
• Payment will align with the practice’s current contract and applicable state law. This may result in a change in the payment rate, as some services may no longer be paid at parity with an in-person office visit. Review your current contract and fee schedule or contact your local UHC provider relations representative for additional information.

Under UHC guidelines, telehealth services must be live, interactive audio and video visits, and recognized by:

• The Centers for Medicare & Medicaid Services (CMS)
• American Medical Association (included in Appendix P of CPT as telehealth)
• UHC (services the company has identified as those that can be effectively performed using telehealth).

From Jan. 1, 2021, through the end of the COVID-19 public health emergency, UHC’s Medicare Advantage plans will align with the CMS telehealth services and guidelines, including allowing certain telehealth services when the patient is at home.

UHC’s new policy also addresses other forms of clinician-patient electronic communication, including virtual check-ins, remote patient monitoring, and E-visits (non-face-to-face, member-initiated communications with providers using online patient portals). For more information, see the policy.

Cigna, another large private insurer, has also changed its telehealth policies for 2021. 

— Brennan Cantrell, commercial health insurance strategist, American Academy of Family Physicians