CurrentUnitedHealthcarePolicy N/A

Telehealth/Telemedicine and virtual health reimbursement

Governs UnitedHealthcare Community Plan Medicaid reimbursement for telehealth, telemedicine, and virtual health services billed on CMS-1500 or UB-04 forms, and applies to all products and providers including network and non-network entities.

Policy Summary

PayerUnitedHealthcare Community Plan

PolicyTelehealth/Telemedicine and virtual health reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionReport telehealth services with an appropriate telehealth modifier (GQ, GT, G0 or 95) to identify the service modality and ensure proper reimbursement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Modifiers requiredModifiers required

Q3014 reimbursableOriginating site fee

RPM, digital E/M, consultsCovered service types

Multiple statesState exceptions

Codes excludedTelephone-only excluded

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Coverage Rules and Exceptions

Coverage rules and exceptions

UnitedHealthcare Community Plan covers Telehealth/virtual services consistent with CMS and AMA guidance with specified modifiers and state exceptions. Reimbursement is allowed for recognized telehealth services when reported with the appropriate telehealth modifier and in compliance with coding, place of service, and documentation requirements. Certain service types are excluded from reimbursement as described below.

Coverage rules

Telehealth services recognized by CMS and appended with modifiers GQ or GT, or G0 (numeric zero) for acute stroke telehealth services, are considered for reimbursement. Services recognized by the AMA included in CPT Appendix P appended with modifier 95 are also considered for reimbursement.
Modifier use must reflect the type of technology and telehealth encounter (interactive audio-video, store-and-forward where applicable).
UnitedHealthcare requires one of the telehealth-associated modifiers (GQ, GT, G0 or 95) to be reported when a service is performed via telehealth to identify the service as a Telehealth/virtual visit. Reimbursement will be considered only when the modifier is used appropriately.
Coding relationships for modifier GQ and modifier 95 are administered through the UnitedHealthcare Community Plan Procedure to Modifier Policy.
UnitedHealthcare recognizes CMS-designated Originating Sites and the originating site facility fee (HCPCS Q3014) may be reported when a Telepresenter is present at an originating site location other than the patient’s home. Q3014 is not reimbursable when the distant site claim uses POS 10 indicating the patient is at home and not receiving originating site services.
Examples of originating sites include physician office, hospital, CAH, RHC, FQHC, SNF, CMHC, mobile stroke unit, and patient home in limited situations (e.g., monthly ESRD assessments and substance use disorder treatment where allowed).
UnitedHealthcare recognizes eligible practitioner types for distant site telehealth reimbursement (e.g., physicians, nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, registered dietitians, clinical psychologists, clinical social workers, CRNAs).
Place of Service (POS) 02 or 10 is recognized but not required; modifiers GQ, GT or 95 are required instead to identify telehealth services when rendered by a distant site provider.
Specific telehealth-related service categories are considered for reimbursement consistent with CMS PFS and CPT guidance, including but not limited to: online digital E/M services (99421-99423; 98970-98972), interprofessional consults (99446-99449; 99451-99452), remote physiologic monitoring (99453, 99454, 99457, 99458, 99473, 99091), remote evaluation of recorded video/images (G2010), brief communication technology-based services/virtual check-ins (98016), opioid use disorder office-based treatment (G2086-G2088), and certain additional services recognized by UnitedHealthcare (e.g., medical genetics 96041; patient self-management education 98960-98962; alcohol/substance abuse screening/intervention 99408-99409; critical care remote E/M G0508/G0509).
These codes must be reported according to AMA/CMS guidelines and with the appropriate modifier when required.
Telehealth transmission per-minute codes (T1014) and telephone-only non-face-to-face E/M codes (CPT 98966-98968; 98008-98016) are considered non-reimbursable per CMS and are treated as included in other services, except where state-specific rules allow otherwise. UnitedHealthcare will not reimburse routine telephone services (98008-98016 or 98966-98968) when they are non-face-to-face management of the patient, or when included in overall management, unless a state exception specifically permits billing under different modifiers or POS combinations.
See Questions & Answers for examples and clarifications regarding telephone services and telehealth.
Documentation for telehealth visits must be equivalent to in-person visits and include notation that the visit was performed via audio-video telecommunications. Documentation should reflect what occurred during the visit.
Maintain standard medical record elements consistent with in-person encounters.

Operational billing rules

Modifier requirements: use GQ, GT, G0, or 95 as applicable. Modifier 26 (professional component) may be used when only the professional component of a diagnostic service is provided from a distant site; modifier GT is not appropriate in that scenario.
UnitedHealthcare enforces appropriate modifier use and follows its Procedure to Modifier Policy.
Originating site facility fee: Q3014 may be billed on professional (CMS-1500) or facility (UB-04) claims when a Telepresenter is present and the patient is not at home. Q3014 is not payable when the distant site claim indicates POS 10 and the patient is at home without originating site services.
Independent renal dialysis facilities are not eligible originating sites; hospital-based renal dialysis centers are eligible.

State exceptions and restrictions

UnitedHealthcare recognizes and follows state and federal telehealth mandates. State-specific billing, modifier, and POS requirements take precedence where applicable and may restrict or expand telehealth coverage compared with the general policy.
See the Attachments/state-specific lists for details per state.
Examples of state exceptions include: Florida requires modifier GT on all telehealth claims and will deny claims billed with modifier 95 or GQ; Florida also has specific reimbursable HCPCS when billed with GT and other unique POS restrictions. Hawaii issued temporary guidance during the COVID-19 PHE to use the POS that would have been rendered with modifier 95, GQ, or GT where appropriate. Idaho Medicaid requires billing POS 02 or 10 and modifier FQ or GT (modifier FR allowed with FQ/GT) and has FQHC/RHC/IHS-specific rules for T1015. Arizona AHCCCS maintains a state-specific telehealth code list allowing FQ, GT, or GQ and POS as originating site. Colorado has no restriction and state regulations supersede the policy. Additional state-specific code lists and modifier/POS rules exist for Indiana, Kansas, Michigan, Mississippi, Missouri, Nebraska, and others as listed in the Attachments.
Providers must consult the state-specific attachment lists for exact code/modifier/POS requirements and any effective date constraints.

Code Groups, Modifiers and State Exceptions

Billing Rules, Modifiers and Originating Site Fee

Billing Rule

Report GQ, GT, G0 or 95 for telehealth services

UnitedHealthcare Community Plan requires one of the telehealth-associated modifiers (GQ, GT, G0 or 95) to be reported when performing a service via Telehealth to indicate the technology used and identify the service as Telehealth/virtual visits. Modifier usage must be appropriate per UnitedHealthcare Procedure-to-Modifier policy; reimbursement will be considered only when the modifier has been used appropriately.

Billing Rule

Report Q3014 only for eligible originating sites (not when patient at home POS 10)

When a Telepresenter is present at an originating site location other than the patient's home, claims for an originating site facility fee may be reported using HCPCS code Q3014 on either a professional (CMS-1500) or facility (UB-04) claim. Q3014 is not reimbursable when the distant site claim indicates the patient is located at home with POS 10 and not receiving Originating Site services.

Key Terms and Service Definitions

Telehealth/virtual health — general definition

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.

IncludesTelehealth/Telemedicine, Communication Technology-Based Services (CTBS), Electronic Visits (E-visits), Virtual Check-Ins, interprofessional telephone/internet/EHR consultations.

TerminologyTerms 'Telehealth' and 'Telemedicine' are used interchangeably in this policy.

Telehealth/Telemedicine (synchronous)

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

Modality

Policy Version History

2026-03-29policy_version_changeLatest

State exceptions updated: Massachusetts; Indiana State Medicaid Modifier 95 in POS 02 updated.

2026-03-15policy_version_change

State exceptions updated: New York; Ohio State Telehealth Code List updated.

2026-03-08policy_version_change

Policy Summary

PayerUnitedHealthcare Community Plan

PolicyTelehealth/Telemedicine and virtual health reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionReport telehealth services with an appropriate telehealth modifier (GQ, GT, G0 or 95) to identify the service modality and ensure proper reimbursement.

SourceLink

On This Page

Billing Rule

Use provider's usual POS — do not file as POS 02 (Minnesota example)

File telehealth claims with the provider's usual place of service code(s) rather than POS 02; claims billed with POS 02 will deny. Exception: hybrid telehealth supported by home visits should be filed with POS 12 (home).

Billing Rule

Follow Texas-specific modifier and audio-only rules (95, 93, FQ)

Texas Medicaid does not allow modifier GT and requires state-specific modifiers (95, 93 for audio-only, and FQ). Some codes have audio-only limitations (e.g., 99211 with modifier 93 only billable during public state emergencies); review the Texas state code list and modifier rules for correct billing.

Do not use GT for Texas Medicaid; use 95, 93 (audio-only) or FQ as specified.
CPT 99211 with modifier 93 is billable only during public state emergencies.
Q3014 billed with modifier 95 is reimbursable for RHCs and FQHCs in Texas.

Billing Rule

Adhere to state-specific modifier and code exceptions (VA, DC, WI, etc.)

Follow state-specific modifier and code exceptions: Virginia and Washington DC permit GT (DC requires GT for telehealth), Wisconsin recognizes GT, GQ, FQ, FR and 93 (with some exemptions), and some states list codes that are excluded or payable only with specific modifiers—refer to the state attachments for exact allowed code/modifier lists.

Washington DC: all Telehealth/Virtual health services must be billed with a GT modifier.
Virginia: state-specific telehealth code list allows GT; see state attachment.
Wisconsin: state list allows GT, FQ, FR, GQ and 93; codes 98000–98015 are exempt from telehealth modifier requirements.

Synchronous (real-time) audio-visual transmission required; asynchronous services are not included in this definition.

Usage notePolicy uses 'Telehealth' and 'Telemedicine' interchangeably when referring to synchronous services.

Telehealth services description

DescriptionTelehealth services are live, interactive audio and visual transmissions of a physician-patient encounter using telecommunications technology; they may include real-time transmissions or store-and-forward technology.

ScopeCovers physician-patient encounters transmitted in real time and may include remote evaluation of recorded video/images (store-and-forward) when allowed.

DocumentationTelehealth visits should be documented to the same extent as in-person visits, noting that the visit used audio-video telecommunications.

Remote Physiologic Monitoring

DefinitionRemote Physiologic Monitoring (RPM) is the collecting of vitals and physiologic information by the patient that is then sent to the health care professional for interpretation and monitoring.

PurposeUsed for interpretation and ongoing monitoring of patient-collected data by a health care professional.

Coding noteRPM-related CPT/Codes are recognized for reimbursement when billed according to CMS/CPT guidance per this policy (see coding sections).

Communication Technology-Based Services (CTBS)

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

ExamplesIncludes certain virtual communications and brief digital interactions that do not meet the synchronous audio-visual Telehealth definition.

Policy implicationCTBS are covered under virtual health provisions distinct from Telehealth/Telemedicine synchronous requirements.

Telephone-only services

DefinitionTelephone-only services are audio transmissions (telephone calls) considered non-face-to-face E/M services rather than Telehealth.

ExclusionsCertain telephone-only CPT codes (98008-98016, 98966-98968) are not reimbursed as standalone services per policy.

Policy rationaleTelephone services are considered included in overall patient management and not payable unless state-specific guidance provides otherwise.

State exceptions updated: New Jersey added; Virginia State Telehealth Code List updated.

2026-01-11policy_version_change

State exceptions updated: Rhode Island.

2025-12-12policy_version_change

State exceptions updated: Tennessee State Medicaid Telehealth Code List updated.

2025-12-07policy_version_change

State exceptions updated: Massachusetts.

2025-11-16policy_version_change

State exceptions updated: Florida.

2025-11-10attachment_change

Tennessee State Medicaid Telehealth Code List added to attachments.

2025-11-09attachment_change

Kansas State Telehealth POS 02 and POS 10 Code Lists updated; Virginia State Telehealth Code List updated.

2025-10-26policy_version_change

State exceptions updated: Virginia.

2025-10-19attachment_change

Texas and Wisconsin State Telehealth Code Lists updated.

2025-10-10attachment_change

Indiana State Medicaid Modifier 93/95 and related code lists updated; Wisconsin State Telehealth Code List updated.

2025-10-05attachment_change

Hawaii State Telehealth Code List updated.

2025-09-07attachment_change

California removed; Hawaii State Telehealth Code List updated.

2025-08-24policy_version_change

State exceptions updated: Texas; Texas State Medicaid Telehealth Code List updated.

2025-08-10attachment_change

Kansas POS 02 and POS 10 Code Lists updated; Nebraska State Modifier 95 & 93 and POS 02 & 10 Telehealth Code Lists updated.

2025-08-05attachment_change

Wisconsin State Telehealth Code List updated; Indiana State Medicaid Modifier 93 and 95 updates applied.

2025-07-20policy_version_change

State exceptions updated: Wisconsin.

2025-07-13attachment_change

California removed; Nebraska State Modifier 95 & 93 and POS 02 & 10 Telehealth Code Lists updated; Texas State Medicaid Telehealth Code List updated; Michigan modifier 95 list updated.

2025-06-29attachment_change

North Carolina State Telehealth Code List updated; Kansas POS 02 and POS 10 Code Lists updated.

2025-06-15attachment_change

Kansas State Telehealth POS 02 and POS 10 Code Lists updated.

2025-06-08policy_version_change

State exceptions updated: Idaho and Texas; Texas and Wisconsin State Telehealth Code Lists updated.

2025-05-25attachment_change

Wisconsin State Telehealth Code List updated.

2025-05-18policy_version_change

State exceptions updated: Idaho.

2025-05-11attachment_change

Kansas and Michigan State Telehealth Code Lists and Michigan modifier 93 and 95 lists updated.

2025-04-27policy_version_change

State exceptions updated: North Carolina; Hawaii State Telehealth Code List updated.

2025-04-20attachment_change

Michigan State Telehealth modifier 93 list updated.