CurrentUnitedHealthcarePolicy 2025R7133X

Reimbursement Policy CMS-1500 and UB04 - Telehealth/Virtual Health

Defines UnitedHealthcare Community Plan's reimbursement rules for telehealth, virtual health, and related remote services billed on CMS-1500 and UB04 forms, including recognized modifiers, eligible codes and originating sites; applies to providers submitting claims to UnitedHealthcare Community Plan.

Policy Summary

PayerUnitedHealthcare

PolicyReimbursement Policy CMS-1500 and UB04 - Telehealth/Virtual Health

Policy CodePolicy 2025R7133X

Change TypeNo material changes noted in this revision

Effective Date

Next Review Date

Key ActionSubmit accurate claims using the procedure code(s) that correctly describe services and report Telehealth services with appropriate Telehealth-associated modifiers (GQ, GT, G0, or 95).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

multipleRecognized code groups

Q3014Originating site fee

requiredDocumentation parity

~20+State deviations

no reimbursement

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Telephone-only non-pay

Telehealth Coverage Criteria

Telehealth reimbursement criteria

UnitedHealthcare Community Plan will consider for reimbursement Telehealth and virtual health services recognized by CMS and AMA when billed with appropriate modifiers and meeting code-specific requirements. Certain services are explicitly recognized as eligible; others are non-reimbursable per CMS guidance.

Report Telehealth services with one of the Telehealth-associated modifiers GQ, GT, G0, or 95 to be considered for reimbursement.

Modifier use must be appropriate to the service and follows UnitedHealthcare Procedure to Modifier Policy.

Originating site facility fee (HCPCS Q3014) may be reported when a Telepresenter is present at an Originating Site; Q3014 is not reimbursable when the distant site claim is reported with POS 10 indicating the patient is at home and not receiving Originating Site services from a Telepresenter.

Q3014 may be reported on either CMS-1500 (professional) or UB-04 (facility) when applicable.

ALL of the following

On-line digital E/M services (CPT 99421-99423, 98970-98972).
Digitally stored data services / Remote Physiologic Monitoring (CPT 99453, 99454, 99457, 99458, 99473, 99091).
Remote evaluation of recorded video/images (HCPCS G2010) with interpretation and follow-up within 24 business hours, not originating from a related E/M in the prior 7 days.
Brief communication technology-based services / Virtual Check-In (CPT 98016).
Office-based treatment for opioid use disorder (G2086-G2088).

ALL of the following

Telehealth transmission per-minute (T1014) is not reimbursable.
Telephone non-face-to-face E/M services (e.g., CPT 98966-98968, CPT range 98008-98016) are not reimbursable when considered non-face-to-face per CMS policy.

Documentation requirements: Telehealth visits must be documented to the same extent as in-person visits and must reflect that the visit was performed via audio-video telecommunications when applicable.

Providers should ensure documentation parity with in-person encounters.

Telehealth coverage and state exceptions

High-level coverage rules and notable state exceptions.

Telephone-only services (codes 98008-98016 and 98966-98968) are generally not reimbursed as they are considered included in overall patient management.

Telehealth services require documentation equivalent to in-person visits and documentation that audio-video telecommunications were used when applicable.

State-specific requirements

Nebraska: All audio/visual telemedicine services must be billed with modifier 95; all audio-only telemedicine services must be billed with modifier 93; state has specified lists for POS 02 and POS 10.
Texas: Does not allow modifier GT; requires modifiers 95, 93 (audio-only), or FQ (audio-only) as applicable; Q3014 with modifier 95 is reimbursable for RHCs/FQHCs; certain mental health E/M codes (99212-99215) are payable with FQ for synchronous telephone in specified contexts.

Eligible Codes, Modifiers, and Non-Reimbursable Codes

Telehealth-eligible CPT/HCPCS codes (recognized with GT, GQ, or G0)mixedCovered

96041	Medical genetics and genetic counseling service
99408	Alcohol/substance abuse screening and brief intervention
99409	Alcohol/substance abuse screening and brief intervention (extended)
G0508	Remote real-time interactive video-conferenced critical care E/M (initial)
G0509	Remote real-time interactive video-conferenced critical care E/M (subsequent)
Q3014	Telehealth originating site facility fee
G2010	Remote evaluation of recorded video/images (store-and-forward)
99453	RPM device setup and patient education
99454	RPM device supply with daily recordings or programmed alert
99457	RPM treatment management services

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Non-reimbursable telephone/transmission codesCPTNot Covered

98966	Telephone assessment and management service provided by a physician to an established patient, 5-10 minutes — non-reimbursable per CMS PFS
98967	Telephone assessment and management service provided by a physician to an established patient, 11-20 minutes — non-reimbursable per CMS PFS
98968	Telephone assessment and management service provided by a physician to an established patient, 21-30 minutes — non-reimbursable per CMS PFS
98008	Telephone/virtual check-in or brief communication technology-based service — non-reimbursable per CMS PFS
98009	Telephone/virtual communication (range) — non-reimbursable per CMS PFS
98010	Telephone/virtual communication (range) — non-reimbursable per CMS PFS
98011	Telephone/virtual communication (range) — non-reimbursable per CMS PFS
98012	Telephone/virtual communication (range) — non-reimbursable per CMS PFS
98013	Telephone/virtual communication (range) — non-reimbursable per CMS PFS
98014	Telephone/virtual communication (range) — non-reimbursable per CMS PFS

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Codes with state-specific modifier rules / exceptionsmixed

98966-98968	Telephone assessment and management services — allowed or restricted by some states (e.g., New Mexico allowed 98966-98968 for dates 07/01/2024-03/31/2025) — check state guidance
98000-98016	Telephone/virtual check-in and brief communication codes — some states (e.g., New York, Texas, Nebraska) permit billing with specific modifiers (93, 95, FQ) or POS limitations; verify state-specific lists/attachments
99441-99443	Physician telephone E/M codes — New York allows with modifiers 93 and/or FQ in POS 02,10,11 per state guidance
99211	In Texas, CPT 99211 with modifier 93 is only billable during public state of emergencies
G9012	In Texas, G9012 billed with U2,U5,95 reimbursable for comprehensive visit; with TS,93 reimbursable for follow-up

Telehealth-associated modifier requirementModifier

GQ	Telehealth modifier - asynchronous telecommunications system
GT	Telehealth modifier - synchronous telemedicine service
G0	Telehealth modifier - related to acute stroke (numeric zero)
95	Synchronous telemedicine service rendered via real-time interactive audio and video

Allowed audio-only modifier

Allowed audio-only modifiers (state-dependent)States may allow audio-only modifiers such as 93 or FQ for specific codes (examples: TX allows 93 and FQ; NE requires 93 for audio-only); verify state attachments and guidance for allowed codes and POS

Audio-only code examplesCPT 99212-99215 may be payable with FQ for synchronous telephone (audio-only) in Texas for established patient mental health/substance use services; CPT 98016 may be billed with modifiers 93, 95, FQ, GT, and GQ in New York when not billed with 98000-98015

Billing, Claims Submission, and Provider Requirements

Billing Rule

Claims submission and modifier requirements

Submit accurate claims using the procedure code(s) that correctly describe services provided. UnitedHealthcare Community Plan requires the appropriate Telehealth-associated modifier to be reported when a service is performed via Telehealth to indicate the technology used and to identify the service as Telehealth/virtual. Report Telehealth services with one of the recognized modifiers (GQ, GT, G0, or 95) or other state-prescribed modifiers as applicable. UnitedHealthcare Community Plan will consider reimbursement for a procedure code/modifier combination only when the modifier is used appropriately and in accordance with CMS, AMA/CPT, and UnitedHealthcare procedure-to-modifier guidance.

Use the modifier that accurately describes the modality: GQ, GT, G0 (numeric zero for acute stroke), or 95 (as recognized by AMA/CPT Appendix P).
Modifier use must follow UnitedHealthcare’s Procedure to Modifier Policy and applicable CMS/AMA coding guidance.
Report Originating Site facility fee (when applicable) with HCPCS code Q3014.

Key Definitions

inv-10: Telehealth/Virtual health

DefinitionTelehealth/Telemedicine and virtual health occur when the Physician or Other Qualified Health Care Professional and the patient are not at the same site; virtual health encompasses synchronous, asynchronous and Remote Physiologic Monitoring (RPM) care between professionals and patients.

ScopeIncludes Telehealth/Telemedicine, Communication Technology-Based Services (CTBS), E-visit, Virtual Check-Ins, interprofessional telephone/internet/EHR consultations, and related services.

Interchangeable termsThe terms Telehealth and Telemedicine are used interchangeably in this policy.

inv-11: Telehealth/Telemedicine (synchronous)

Synchronous telehealthTelehealth/Telemedicine services only include live, interactive audio and visual transmissions of an encounter from one site to another using telecommunications technology (synchronous only).

Policy Summary

PayerUnitedHealthcare

PolicyReimbursement Policy CMS-1500 and UB04 - Telehealth/Virtual Health

Policy CodePolicy 2025R7133X

Change TypeNo material changes noted in this revision

Effective Date

Next Review Date

Key ActionSubmit accurate claims using the procedure code(s) that correctly describe services and report Telehealth services with appropriate Telehealth-associated modifiers (GQ, GT, G0, or 95).

SourceLink

On This Page

North Carolina: Requires GT modifier for two-way audio-visual in certain contexts and has state-specific filing/pos rules noted in attachments.

Virginia, Washington DC, Wisconsin, Washington and others: Have state-specific allowed code lists and modifier requirements; see attachments for per-state code/modifier lists.

Where state rules differ from this policy, state Medicaid regulations and attachments take precedence; providers should consult the attachments for state-specific code lists and modifier/POS instructions.

Prior Authorization

State modifier/POS billing actions

Follow state-specific modifier and place-of-service (POS) billing rules. Some states require certain modifiers or prohibit others except in limited POS — always apply the state-prescribed modifier(s) and POS when billing Telehealth services.

Missouri: state-specific list of codes for POS 02; modifiers 95, G0, GQ, and GT are not allowed for billing except in POS 02 (Telehealth) and POS 03 (school). See Attachments for Missouri’s state list.
New Mexico: requires modifier GT when reporting services delivered via School Based Health Centers (SBHC). Per New Mexico guidance, CPT codes 98966–98968 are allowed for dates of service 07/01/2024–03/31/2025. New Mexico allows the home of an individual as an originating site when an interactive audio/video system permits a real-time visit.
Nebraska: state-specified list of codes allowed in POS 02 (Telehealth) and POS 10; all audio/visual telemedicine services must be billed with modifier 95; all audio-only telemedicine services must be billed with modifier 93.
New York: state-specific restrictions (e.g., COVID vaccines not payable in POS 02 or 10) and allowances (see full state guidance for permitted CPT/modifier/POS combinations).

Technology requirement

Requires real-time audio and visual interaction between sites to qualify as Telehealth/Telemedicine under this policy.

TerminologyPolicy uses Telehealth/Telemedicine specifically to denote synchronous, live audio-visual encounters.

inv-12: Originating Site

Originating Site definitionOriginating Site is the location of the patient at the time the service being furnished via a telecommunications system occurs; UnitedHealthcare recognizes CMS-designated Originating Sites as eligible for furnishing Telehealth services.

ExamplesExamples include physician office; hospital (inpatient/outpatient); critical access hospital (CAH); rural health clinic (RHC); federally qualified health center (FQHC); hospital-based renal dialysis center (not independent dialysis facilities); skilled nursing facility (SNF); community mental health center (CMHC); Mobile Stroke Unit; and patient home in limited circumstances.

Q3014 guidanceClaims for Originating Site services may be reported using HCPCS code Q3014 when a Telepresenter is present at an originating site; Q3014 is not reimbursable when the distant site claim is reported with POS 10 indicating the patient is at home without a Telepresenter.

inv-13: Telehealth/Telemedicine

Short definitionTelehealth/Telemedicine refers to encounters where the clinician and patient are not co-located and care is delivered via telecommunications technology.

Includes virtual care typesMay include synchronous, asynchronous, RPM, CTBS, e-visits, virtual check-ins, and interprofessional consultations as part of virtual health.

inv-14: CTBS

CTBS definitionCommunication Technology-Based Services (CTBS) are services furnished via telecommunications technology considered under virtual care but not considered Telehealth services.

Distinction from telehealthCTBS are classified as virtual care separate from Telehealth/Telemedicine (which requires live audio-visual transmission).

Examples included in virtual healthCTBS are part of the broader virtual health category alongside E-visits, virtual check-ins, and RPM.

inv-15: E-visit

E-visit definitionE-visit is communication between a patient and provider through an online patient portal.

ClassificationE-visits are included within virtual health as asynchronous electronic communication distinct from synchronous Telehealth/Telemedicine.

Policy inclusionE-visits are recognized as a form of virtual health in the policy's scope of services considered for reimbursement when reported per applicable coding guidance.