CurrentOptumPolicy N/A

Telehealth/Telemedicine behavioral health reimbursement

Governs Optum reimbursement rules for behavioral health telehealth/telemedicine services billed on CMS 1500 and, when specified, UB-04 and electronic claims; applies to providers submitting claims for members whose behavioral health benefits are administered by Optum (including UnitedHealthcare) for applicable commercial and exchange plans.

Policy Summary

PayerOptum

PolicyTelehealth/Telemedicine behavioral health reimbursement

Policy CodePolicy N/A

Change TypeAddedClarifiedRevised

Effective Date

Next Review DateFeb 1, 2026

Key ActionSubmit claims on CMS 1500 or electronic 837p (and UB-04 when specified) and report services with the appropriate POS (02 or 10) and modifiers per policy.

SourceLink

POLICY UPDATE CHANGES

Added Q&A clarifying Optum will not reimburse new 2025 CPT codes 98000-98015 and directing providers to report E/M visit services (99202-99205, 99211-99215) with POS 02 or 10 instead.

Clarified that Optum will not reimburse CPT Q3014 originating site facility fee when billed with POS 02 or 10.

Updated guidance on modifiers: Optum accepts modifiers 93, 95, GT as informational with POS 02 or 10; audio-only services reimbursed only when billed with modifier 93 and/or when mandated by state regulation or member benefit.

POS 02, POS 10designated telehealth place-of-service codes accepted

93, 95, GTaccepted informational telehealth modifiers

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Telehealth Reimbursement Coverage Criteria

Telehealth reimbursement criteria

Covered when ALL of the following criteria are met:

ALL of the following

ALL of the following
- Provider must be legally authorized and hold a valid license to provide mental health and/or substance abuse services in the state where the member is receiving services and must perform services within the scope of that license.
ALL of the following
- Services must be delivered via live, interactive audio-and-video telecommunications (synchronous). Audio-only services are eligible for reimbursement only as specified elsewhere in this policy (see audio-only rules).
ALL of the following
- Report the member's location on the claim using POS 02 (Telehealth Provided Other than in Patient's Home) or POS 10 (Telehealth Provided in Patient's Home). POS is required in Box 24B on the CMS 1500 claim form.
ALL of the following
- Report eligible telehealth CPT codes recognized by CMS, AMA (Appendix P), or additional Optum-identified behavioral health services that can be effectively performed via telehealth.
- Do not report CPT codes 98000-98015; Optum will not reimburse these 2025 codes. Instead report the appropriate replacement E/M visit codes (for example, 99202-99205, 99211-99215) appended with POS 02 or POS 10 as applicable.
- Do not report CPT Q3014 when billed with POS 02 or POS 10; Optum will not reimburse Q3014 in that context. For originating-site reporting, use the valid POS reflecting the patient's location.
ALL of the following
- Modifiers 93, 95, and GT are accepted as informational when reported with eligible telehealth services and POS 02 or 10.
- Audio-only services: reimbursement allowed only when billed with modifier 93 and when mandated by state regulation and/or covered by the member's benefit plan; modifier FQ is reserved for services provided as part of an FQHC or RHC and is not a substitute for modifier 93 for audio-only telehealth reimbursement.
ALL of the following
- Telehealth visits must be documented to the same extent as in-person visits, reflecting what occurred during the visit, and the record must note that the visit was conducted via audio-video telecommunications. Follow Behavioral Health Documentation Protocols for details.
ALL of the following
- Submit claims on the CMS 1500 or electronic 837p (and UB-04 when specified). Coverage is subject to the member's benefit plan, provider contract terms, and applicable state mandates; this policy applies to both participating and non-participating providers when out-of-network coverage is included.

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Place-of-Service, Modifiers, and Code Guidance

Accepted Telehealth Modifiers (Informational)Modifier

93	Synchronous audio-only telemedicine service — use when service delivered via audio-only (required by Optum for audio-only reimbursement).
95	Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system (informational; accepted).
GT	Via interactive audio and video telecommunications systems (informational; accepted).

Place of Service for TelehealthRevenue

02	POS 02 — Telehealth Provided Other than in Patient's Home. Patient not located in their home when receiving services via telecommunication technology.
10	POS 10 — Telehealth Provided in Patient's Home (effective 1/1/2022). Patient located in their home when receiving services via telecommunication technology.

Audio-only reimbursement

Audio-only reimbursementAllowed only when billed with modifier 93 and when state regulation or member benefit mandates coverage. Modifier FQ is NOT acceptable for audio-only telehealth reimbursement unless applicable to FQHC/RHC billing rules.

Claims Submission & Provider Billing Actions

Billing Rule

Claims submission and applicability — use CMS 1500/837p (UB-04 when specified) and bill only covered services

Submit professional claims on the CMS 1500 form or electronically via 837p; use UB-04 only when the policy or service specifically requires facility billing on UB-04. Ensure the services billed are consistent with the member's benefit coverage, provider contract terms, and the telehealth place-of-service and modifier guidance in this policy.

Submit CMS 1500 or electronic 837p for professional services; UB-04 applies when specified.
Verify the member's benefit plan covers the billed telehealth service before submission.
Follow POS and modifier guidance (e.g., report POS 02 or POS 10 and accepted informational modifiers) as described in this policy.

Key Definitions

Definition of Telehealth/Telemedicine (inv-05)

DefinitionLive, interactive audio and visual transmissions of an encounter from one site to another using telecommunications technology (synchronous only).

ScopeIncludes real-time interactive audio-video encounters; terms Telemental, Telehealth, and Telemedicine are used interchangeably in this policy.

ExclusionPolicy defines telehealth as synchronous only for purposes of reimbursement (audio-video); audio-only treated separately under specific rules.

Telehealth Provided Other than in Patient's Home (inv-06)

POS codePOS 02 — Telehealth Provided Other than in Patient's Home: location where health services are provided/received via telecommunication technology when the patient is not located in their home.

Claim reporting