April 14, 2021
Area(s) of Interest: Payor Issues and Reimbursement
UnitedHealthcare (UHC) is now requiring physicians to bill eligible telehealth services with place of service (POS) 02 for commercial products. Telehealth claims with any other POS will not be considered eligible for reimbursement.
While the policy – announced in United’s October 2020 Reimbursement Policy Update Bulletin – became effective January 1, 2021, UHC advises that an unofficial transition period for payment of claims not billed with POS 02 was in place through mid-March. Effective March 13, 2021, telehealth claims not billed with POS 02 will not be paid and providers will be required to resubmit a corrected claim.
The change implemented by UHC aligns with the California Department of Managed Health Care (DMHC) all plan letter (APL) issued on September 4, 2020, which reminded DMHC-regulated health plans of the continued requirement to reimburse providers at the same rate for telehealth services, including telephonic visits, as they would for services provided in person. This APL clarified that the prior APLs (20-009 and 20-013) remain in effect for the duration of California’s declared state of emergency or until further notice from DMHC, whichever is earlier. The APL also clarified that these requirements apply to delegated entities to the extent the health plan delegated the services impacted by these APLs.
On March 30, 2020, the California Department of Insurance (CDI) issued guidance requiring CDI-regulated insurance companies to reimburse providers at the same rate for telehealth services as they would for services provided in person. Insurers were also required to reimburse a service provided telephonically at the same rate as services provided via video. These requirements are in effect throughout the declared COVID-19 state of emergency.
For more information see: UnitedHealthcare Telehealth Services: Care Provider Coding Guidance.