APTA Alabama continues to monitor payment news for Telehealth coverage

UnitedHealthcare is continuing its expansion of telehealth access, including temporarily waiving the Centers for Medicare & Medicaid Services (CMS) originating site requirements and temporarily reimbursing claims for physical, occupational and speech therapists for certain services performed using live interactive video-conferencing while a patient is at home. 

·        For Medicare Advantage plans, self-funded Group Market health plans, and Individual and fully insured Group Market health plans, this extension applies for dates of services through Sept. 30, 2020. (For Medicare Advantage plans, this date is subject to change based on direction from CMS.)

UnitedHealthcare will reimburse claims including one of the CPT codes from the list, as long as claims are submitted on a CMS 1500 form using the place of service that would have been reported had the services been furnished in person along with a 95 modifier, or on a UB04 form with applicable revenue code and a CPT code with a 95 modifier. These coding rules apply to all lines of business. Please click HERE to see CPT codes that are accepted under this policy change. UnitedHealthcare will not reimburse providers for audio-only visits. All visits must be performed using live interactive video-conferencing that involves the presence of both parties at the same time and a communication link between them that allows a real-time audio and visual interaction to take place. E-mailing “stored” exercise videos and discussing or reviewing by phone is not reimbursable. State law and licensing board requirements apply to all providers’ provision of physical, occupation and speech therapy services through telehealth.


BCBS of Alabama has not yet announced whether they will be extending coverage. Contact has been made, and news will be shared when it is received.


ALABAMA MEDICAID – On Friday, Medicaid extended its allowance of telehealth.


The new expiration date is the earlier of July 31, 2020, the conclusion of the COVID-19 National emergency, or any expiration date noticed by the Alabama Medicaid Agency through a subsequent ALERT.