CurrentOptumPolicy N/A

Telehealth/Telemedicine behavioral health reimbursement

Defines Optum reimbursement policy for telemental/telehealth behavioral health services billed to Medicare and other products administered by Optum, including who may bill and billing requirements.

Policy Summary

PayerOptum

PolicyTelehealth/Telemedicine behavioral health reimbursement

Policy CodePolicy N/A

Change TypeClarified and revised originating site and billing guidance

Effective DateN/A

Next Review DateN/A

Key ActionEnsure services are live interactive audio/visual telehealth, furnished by authorized providers licensed in the state where the member is located, and billed with POS 02 or POS 10 as appropriate.

SourceLink

POLICY UPDATE CHANGES

Optum will not reimburse for CPT code Q3014 when billed with POS 02 or 10; report the valid POS reflecting patient location instead.

Added POS 10 (patient home) as recognized telehealth originating site and updated reimbursement guidelines to accept POS 02 or 10 for CMS-approved telehealth services.

Removed the GT modifier as an acceptable billing practice (noted in history).

2CMS POS codes dedicated to telehealth (02 and 10)

98966-98968Telephone CPT codes referenced

G2086-G2088Opioid treatment HCPCS codes

2026-02Doc revision month

Policy Summary

PayerOptum

PolicyTelehealth/Telemedicine behavioral health reimbursement

Policy CodePolicy N/A

Change TypeClarified and revised originating site and billing guidance

Effective DateN/A

Next Review DateN/A

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Telehealth Coverage Criteria

Telehealth coverage criteria

Optum will reimburse CMS-approved telehealth services when all Medicare telehealth requirements are met and correctly billed.

ALL of the following

ALL of the following
ALL of the following
ALL of the following
ALL of the following
ALL of the following
ALL of the following
ALL of the following

ANY of the following

Place of Service, Modality, and Recognized Codes

Place of Service codes and originating site facility feemixedCovered

POS 02	Telehealth location where patient is not at home
POS 10	Patient located in their home during telehealth encounter
Q3014	Telehealth originating site facility fee (not reimbursed when billed with POS 02 or 10 by Optum)

Telephone CPT codesCPT

98966-98968

Telephone E/M services (considered when billed with POS 02 or 10 per CMS guidance)

Opioid treatment codesHCPCSCovered

G2086-G2088

Office-based treatment for opioid use disorders

Telehealth modality requirement

RequirementService must be furnished via live interactive audio and video (interactive telecommunications system)

ApplicabilityApplies to CMS-approved telehealth services reimbursed with POS 02 or POS 10

ProviderMust be furnished by a physician or authorized practitioner as required by Medicare

Provider Billing and Documentation Actions

Billing Rule

Provider billing and authorization actions — live audio/visual telehealth required

Ensure telehealth services are live, interactive audio/video encounters furnished by authorized providers licensed in the state where the member is located. Use the appropriate telehealth POS code (02 or 10) to certify the service meets telehealth requirements. Document the visit to the same extent as an in-person visit and explicitly note that the encounter was performed via audio-visual telecommunications. Providers must follow applicable billing requirements and only bill for services that meet CMS/Optum telehealth criteria.

Telehealth services must be live, interactive audio/visual transmissions
Provider must be authorized and licensed in the state where the patient is located
Use POS 02 (patient not at home) or POS 10 (patient at home) when billing

Billing Rule

Telephone service billing guidance — do not bill audio-only calls as standalone visits

Do not bill for telephone-only (audio-only) non–face-to-face services as standalone reimbursable visits. Telephone-only calls that do not require direct, in-person contact are considered part of overall patient management and are not separately payable. If telephone codes are used in conjunction with other services on the same day, ensure correct use of modifiers, POS, and documentation to justify separate payment per Optum/CMS guidance.

Key Terms and Definitions

Interactive (Live) Telehealth

DefinitionLive interactive audio and visual transmissions between patient and distant provider; patient must be present and participating.

SynonymsTelehealth, Telemedicine, Telemental (terms used interchangeably in this policy)

Real‑time requirementMedical information is communicated in real-time with interactive audio and video communications equipment

Asynchronous (Store-and-Forward) Telehealth

DefinitionMedical information is stored and forwarded to be reviewed later by a physician or health care practitioner at a distant site without the patient present (store-and-forward).

Also calledAsynchronous telecommunication or non-interactive telecommunication