An Update from UnitedHealthcare
May 13, 2020
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.