On January 1, 2021, outpatient physical, occupational and speech therapy services provided via telehealth for UnitedHealthcare (UHC) commercial plans will be changing and there will be a difference in telehealth coverage between providers who submit claims on a 1500-claim form and providers who submit claims on a UB-04 claim form.
Question
What is changing on January 1, 2021 for UHC Commercial plans?
Answer
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Question
What place of service (POS) code is to be used on the claim form for an outpatient therapy visit conducted via telehealth?
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Question
What is changing on January 1, 2021 for UHC Medicare Advantage plans?
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Mr. Gawenda has presented nationally since 2004 and currently presents approximately 100 dates per year around the United States.
“To access the UHC Telehealth/Telemedicine Policy, Professional, click HERE” ……..this option keeps failing and states “failed load of PDF”
That is a UHC issue and hopefully they will fix that soon.
COVID-19 Physical Health, Occupational and Speech Therapy
Last update: December 30, 2020, 12:45 a.m. CST
UnitedHealthcare will reimburse physical, occupational and speech therapy (PT/OT/ST) telehealth services provided by qualified health care professionals when rendered using interactive audio-video technology.
Reimbursable codes are limited to the specific set of physical, occupational and speech therapy codes listed here.Opens in a new window UnitedHealthcare will reimburse eligible codes using the place of service that would have been reported had the services been furnished in person on a CMS 1500 with 95 modifier or a UB04 form with applicable revenue codes.
I read this to indicate that facilities billing using a UB04 will be reimbursed after 1/1/2021. Am I reading this incorrectly?
Go back to that same website and click on “Individual and Fully Insured Group Market Health Plans” Under Non-COVID 19 Visits, notice the expiration date of telehealth.
Now that PT providers are to report POS 02 – is a modifier still required? Previously, we were billing POS 11 with Modifier 95. Can you confirm? I do not see detail on modifier requirements for 1500 forms in the UHC Telehealth Policies. Thank you.
Please read the UHC telehealth policy on the top of page 2 for your answer.
For the UHC Advantage plan due you continue to use 95 modifier & POS 11. on the UHC site they still have the telehealth policy that was up to date s of Dec. 21, 2021 for the UHC medicare advantage plan.
You would follow the instructions UHC gives for telehealth services for Medicare Advantage beneficiaries. If you have questions, I would recommend you contact UHC.
It appears with the extension of the public health emergency that United will now again still reimburse UB billers for PT, OT and ST done via telehealth.
The website indicates this policy was updated Jan 11 after you wrote this article.
Is this correct.
Dan
My interpretation, no.
Always verify benefits and coverage, especially for Telehealth coverage. It makes a difference on whether your office is “In-Network” or “Out-of-Network” when providing telehealth treatment. During the 2020 pandemic UHC claims/recoupment departments are stating that only some plans cover telehealth for out of network providers which ended 7/24/20 – even though documentation and articles state otherwise. They are issuing refund requests.
Thank you for the added tip/experience.