CurrentUnitedHealthcarePolicy 2025R0046C

Telehealth and Virtual Health Reimbursement (CMS-1500)

Reimbursement rules for telehealth, virtual health, CTBS, E-visits, and RPM services billed on the CMS-1500 (professional) claim for UnitedHealthcare Commercial and Individual Exchange products, covering in- and out-of-network physicians and other qualified health care professionals.

Policy Summary

PayerUnitedHealthcare

PolicyTelehealth and Virtual Health Reimbursement (CMS-1500)

Policy CodePolicy 2025R0046C

Change TypeRevised + Added guidance

Effective Date

Next Review Date

Key ActionSubmit claims for professional telehealth services on the CMS-1500 (or electronic equivalent) form.

SourceLink

POLICY UPDATE CHANGES

Reimbursement Guidelines section revised for handling of codes 98000-98015.

Telehealth Audio-Only Eligible Services Code List updated and guidance to use modifier 93 for audio-only services appended with POS 02 or 10.

POS 10 (Telehealth Provided in Patient's Home) recognized effective 1/1/2022 for distant site claims; guidance that Q3014 is not reimbursable when POS 10 is used on the distant site claim.

POS 02, 10Acceptable places of service for distant site telehealth

modifier 93Required modifier for audio-only Telehealth per this policy

Q3014Originating site facility fee code; not payable with distant site POS 10

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Telehealth Coverage Criteria

Coverage stance and criteria for telehealth and related virtual services billed on CMS-1500:

Distant Site Telehealth: Eligible telehealth services must be rendered via interactive audio and video and reported with place of service POS 02 or POS 10; eligible services include CMS-recognized telehealth services, AMA Appendix P codes, and additional UnitedHealthcare‑identified services (see Telehealth Eligible Services Code List).

PT/OT/ST Telehealth: Physical, occupational, and speech therapy telehealth services are reimbursable only when furnished using live, interactive audio and video (synchronous); claims must be reported with POS 02 or POS 10 and appropriate PT/OT/ST eligible codes.

Audio‑Only Telehealth: Services included in CPT Appendix T may be reimbursed when delivered as real‑time, interactive audio‑only encounters and appended with modifier 93; these claims must also report POS 02 or POS 10. CPT codes reported with modifier 93 that are not in Appendix T are not eligible for reimbursement.

CTBS and RPM: Communication Technology‑Based Services (CTBS) — including E‑visits, virtual check‑ins, and interprofessional electronic consults — and Remote Physiologic Monitoring (RPM) are considered for reimbursement per the CMS Physician Fee Schedule; these services should not be reported with distant site POS 02 or 10 and should not be reported with telehealth modifiers (95, GT, GQ, G0).

Exclusions

Non‑Reimbursable CTBS: Certain CTBS and related services that CMS assigns non‑payable status are not reimbursed by UnitedHealthcare (see Non‑Eligible Code List in attachments).
Replacement Codes Guidance: For reimbursement guidance regarding codes 98000–98015, refer to the Replacement Codes Policy, Professional.

Originating Site Fee and Billing Rules: The originating site facility fee (Q3014) may be reported for the originating site when applicable (telepresenter present and patient at an eligible originating site); Q3014 is not reimbursable when the distant site claim reports POS 10. Distant site is reported in Box 24B on the CMS‑1500 form.

Claim Submission and Documentation: Claims for professional telehealth services must be submitted on the CMS‑1500 (or electronic equivalent) form; telehealth visits should be documented to the same extent as in‑person visits and include documentation that the encounter occurred via audio‑video (or audio‑only when applicable).

Place of Service, Modifiers, and Codes

Telehealth Distant Site POSmixedCovered

POS 02	Telehealth Provided Other than in Patient's Home
POS 10	Telehealth Provided in Patient's Home (effective 1/1/2022)

Audio-Only TelehealthModifierCovered

modifier 93

Used to identify real-time, interactive audio-only telehealth services (append to CPT Appendix T codes and report with POS 02 or 10)

Originating Site Facility FeeHCPCSNot Covered

Q3014

Telehealth Originating Site facility fee (reportable when telepresenter present at an Originating Site other than patient home; not reimbursable when distant site claim reports POS 10)

PT/OT/ST Video Requirement — Synchronous Audio-Video Required for Reimbursement

RequirementPT/OT/ST telehealth reimbursable only when performed using live, interactive audio and video (synchronous).

Place of ServiceUse POS 02 or POS 10 on the CMS-1500 (Box 24B) for PT/OT/ST telehealth claims.

Eligible CodesSubmit codes from the PT/OT/ST Telehealth Eligible Services Code List (see Attachments).

Non-reimbursableAsynchronous methods (e.g., emailing stored exercise videos) or phone-only review are not reimbursable for PT/OT/ST.

Claim Submission and Billing Guidance

Billing Rule

Submit telehealth professional claims on CMS-1500 (or electronic equivalent)

Claims for professional telehealth services must be submitted on the CMS-1500 form or its electronic equivalent. This requirement applies to all products and to participating and non‑participating providers (including non‑network authorized and percent‑of‑charge contract physicians and other qualified health care professionals).

Key Definitions

Telehealth / Telemedicine — Definition

DefinitionTelehealth / Telemedicine: live, interactive audio and visual transmissions of a physician-patient encounter from one site to another using telecommunications technology.

IncludesMay include real-time telecommunications or store-and-forward transmissions.

ContextApplies to physician-patient encounters facilitated by telecommunications technology.

CTBS — Communication Technology‑Based Services Definition

DefinitionCommunication Technology-Based Services (CTBS): Services furnished via telecommunications technology considered virtual care but not considered Telehealth services.

ExamplesCTBS are distinct from telehealth and include virtual care modalities referenced elsewhere in the policy.