UnitedHealthcare Community Plan follows CMS and AMA coding guidance for telehealth and recognizes additional services for reimbursement when billed with appropriate modifiers and codes; state-specific exceptions apply.
Telehealth services must be reported with one of the Telehealth-associated modifiers (GQ, GT, G0 or 95) to be considered for reimbursement; modifier use must be appropriate per payer Procedure-to-Modifier policy.
Originating site facility fee (HCPCS Q3014) may be billed on professional (CMS-1500) or facility (UB-04) claims when a Telepresenter is present at an originating site other than the patient’s home; Q3014 is not reimbursable when the distant site claim indicates the patient is located at home (POS 10).
Transmission-per-minute code T1014 and similar telehealth transmission-per-minute codes are non-reimbursable and considered included in other services per CMS PFS.
Telephone non-face-to-face E/M codes (98008-98016, 98966-98968) are not reimbursable as standalone services and are considered included in overall management, subject to state exceptions where explicitly allowed.
Online digital E/M services (e.g., 99421-99423 and 98970-98972) are eligible for reimbursement when reported according to AMA/CPT guidelines.
Interprofessional consult codes (CPT 99446-99449, 99451-99452) are eligible for reimbursement per CMS PFS when billed consistent with CMS guidance.
Remote physiologic monitoring and digitally stored data services (CPT 99453, 99454, 99457, 99458, 99473 and 99091) are eligible for reimbursement per CMS PFS.
Remote evaluation of recorded video/images (G2010) is eligible when submitted by an established patient, not originating from a related E/M service within the prior 7 days, and with required follow-up within 24 business hours.
Brief communication technology-based services (Virtual Check-In, e.g., 98016) are eligible for established patients when not related to a recent E/M and meeting time thresholds (5-10 minutes), per CMS PFS.
Opioid use disorder office-based treatment codes (G2086-G2088) are considered eligible for reimbursement for dates of service on or after January 1, 2020 per CMS PFS.
UnitedHealthcare recognizes a range of practitioners eligible to furnish telehealth (physicians, NPs, PAs, nurse-midwives, CNS, RDs, clinical psychologists, social workers, CRNAs), subject to state scope-of-practice and specialty limitations.
Place of Service (POS) filing: UnitedHealthcare recognizes but does not require POS 02 or 10 for distant-site telehealth encounters; providers should report the provider's usual POS and use required telehealth modifiers, except where state rules mandate POS usage or an exception applies (e.g., hybrid telehealth with home visits filed as POS 12).
State-specific variations
North Carolina: Codes not covered for telehealth include G2010, 99451-99452, G2068-G2088, and 99091; NC Medicaid will allow codes 99474, G0071, and T1015 without a GT modifier; Q3014 submitted with a GT modifier is allowed; telehealth claims should be filed with the provider's usual POS (not POS 02) except hybrid exception.
Texas: GT modifier is not allowed for Texas Medicaid; telehealth services must be billed with modifier 95, 93 (audio-only), or FQ; Texas has state-specific allowed code lists and additional rules (e.g., CPT 99211 with modifier 93 only during public state emergencies; Q3014 with 95 reimbursable for RHCs/FQHCs).
Tennessee: Telehealth is covered broadly by state legislation; certain audio-only billing with modifier 93 may be subject to reimbursement adjustments (see state attachments).
Other states (examples: AZ, CO, FL, HI, ID, MN, OH, PA, RI, VA, WI) have specific modifier, POS and code lists or temporary COVID-era rules that affect reimbursement — follow the state-specific attachments and regulations.
Documentation: Telehealth visits must be documented to the same extent as in-person visits and indicate that the encounter was furnished via audio-video telecommunications (or other modality as applicable).