An Update from UnitedHealthcare
May 13, 2020

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In a notice dated May 4th, UnitedHealthcare announced that they will reimburse telehealth services submitted by chiropractors when provided by qualified health care professionals and rendered using interactive audio-visual technology for Medicaid, and Individual and fully insured Group Market health plan members. Medicare Advantage coverage limitations still apply, as well state laws and regulations. Benefits will be processed in accordance with the member’s plan.

Cost-sharing will be waived for in-network telehealth visits for chiropractic services from March 31, 2020 until June 18, 2020 for Medicaid, Individual and fully insured Group Market health plan members, with opt-in available for self-funded employers.

This change is effective for dates of service from March 18, 2020 until June 18, 2020.
Reimbursable codes are limited to the specific set of codes listed here. 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.

UnitedHealthcare is temporarily expanding care provider telehealth access for Medicaid, and Individual and fully insured Group Market health plan members by reimbursing claims submitted by chiropractors for certain services performed using live video-conferencing while a patient is at home. This change applies for dates of services from March 18, 2020 until June 18, 2020. Benefits will be adjudicated and claims will be processed in accordance with the member’s benefit plan and your participation agreement (if applicable). State law and licensing board requirements apply to all providers’ provision of chiropractic services through telehealth. 

UnitedHealthcare will reimburse claims including one of the CPT® codes from the list, as long as claims are submitted 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. These coding rules apply to all lines of business. 

Please CLICK HERE to see CPT codes that are accepted until June 18, 2020 under this policy change. UnitedHealthcare will not reimburse providers for audio-only visits. 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. Providers must always comply with the requirements of the state that issues their license in providing services.