UnitedHealthcare Telehealth Services:

Care Provider Coding Guidance

The following scenarios are intended as a The scenarios in this
guide to help you understand how
UnitedHealthcare will reimburse telehealth
document apply for
services during the COVID-19 emergency dates of service
period. You as a provider are responsible March 18 through
to ensure you submit accurate claims in June 18, 2020, unless
accordance with state and federal laws and
UnitedHealthcare’s reimbursement UnitedHealthcare
policies. The scenarios are not intended to extends the end date.
cover every telehealth service you may
perform during the COVID-19 emergency
period. As such, please see
UHCprovider.com and UnitedHealthcare’s
reimbursement policies for Medicare
Advantage, Medicaid and
commercial. Medicaid state-specific
coding may apply and differ from those
illustrated in these examples.

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 Telehealth Scenario 1: Established patient visit with a provider who uses an audio-video
or audio-only telecommunications system for COVID-19 or non-COVID-19 related care.

Patient Scenario Visit Billing

Established patient presents for a telehealth • Scheduled or same day telehealth visit Step 1. Use appropriate Office Visit E/M
visit using HIPAA-compliant or non-HIPAA- with an established patient code (99211-99215)
compliant audio-video or audio-only technology • Use of HIPAA-compliant or non-HIPAA- Step 2. Use place of service that would have
for COVID-19 or non-COVID-19 related care not compliant audio-video or audio-only been reported had the service been
resulting in COVID-19 diagnostic testing. technology, such as FaceTime or Skype* furnished in person (11, 20, 22, 23)
• Care is delivered by a physician, nurse Step 3. Use 95 modifier for commercial,
practitioner or physician assistant Medicare Advantage and Medicaid*
Step 4. Refer to Centers for Disease
Control and Prevention (CDC)
ICD-10-CM Official Coding
Guidelines
*United States Department of Health and Human
Services (HHS) is exercising enforcement discretion
Medicaid* state specific rules for modifiers and
and waiving penalties of HIPAA during the COVID-19
POS apply.
emergency period.

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 Telehealth Scenario 2: Established patient visit with a provider who uses an audio-video
or audio-only telecommunications system for evaluating need for COVID-19 testing.

Patient Scenario Visit Billing

Established patient presents for a telehealth • Scheduled or same day telehealth visit with Step 1. Use appropriate Office Visit E/M
visit using HIPAA-compliant or non-HIPAA- an established patient code (99211-99215)
compliant audio-video or audio-only technology • Use of HIPAA-compliant or non-HIPAA- Step 2. Use place of service that would have
for evaluating need for COVID-19 testing. compliant audio-video or audio-only been reported had the service been
technology, such as FaceTime or Skype* furnished in person (11, 20, 22, 23)
• Care is delivered by a physician, nurse Step 3. Use 95 modifier for commercial,
practitioner or physician assistant Medicare Advantage and Medicaid*
Step 4. Refer to CDC ICD-10-CM Official
Coding Guidelines

*HHS is exercising enforcement discretion and waiving

penalties of HIPAA during the COVID-19 emergency Medicaid* state specific rules for modifiers and
period. POS apply.

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 Telehealth Scenario 3: Established patient with COVID-19 diagnosis visits with a
provider who uses an audio-video or audio-only telecommunications system.

Patient Scenario Visit Billing

Established patient, who has been confirmed • Scheduled or same day telehealth visit Step 1. Use appropriate Office Visit E/M
positive for COVID-19, presents for a telehealth with a patient that you have seen in the code (99211-99215)
visit using HIPAA compliant or non-HIPAA- past three years Step 2. Use place of service that would have
compliant audio-video or audio-only technology • Use of HIPAA-compliant or non-HIPAA- been reported had the service been
for COVID-19 related or non-COVID-19 follow- compliant audio-video or audio-only furnished in person (11, 20, 22, 23)
up care. technology, such as FaceTime or Skype* Step 3. Use 95 modifier for commercial,
• Care is delivered by a physician, nurse Medicare Advantage and Medicaid*
practitioner or physician assistant Step 4. Refer to CDC ICD-10-CM Official
Coding Guidelines

*HHS is exercising enforcement discretion and waiving

penalties of HIPAA during the COVID-19 emergency Medicaid* state specific rules for modifiers and
period. POS apply.

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 Telehealth Scenario 4: New patient visit with a provider who uses an audio-video or
audio-only telecommunications system COVID-19 or non-COVID-19 related care.

Patient Scenario Visit Billing

New patient* presents for a telehealth visit • Scheduled or same day telehealth visit with Step 1. Use appropriate Office Visit E/M
using HIPAA-compliant or non-HIPAA- a new patient code (99201-99205)
compliant audio-video or audio-only technology • Use of HIPAA-compliant or non-HIPAA- Step 2. Use place of service that would have
for COVID-19 or non-COVID-19 related care compliant audio-video or audio-only been reported had the service been
without COVID-19 diagnostic testing. technology, such as FaceTime or Skype* furnished in person (11, 20, 22, 23)
• Care is delivered by a physician, nurse Step 3. Use 95 modifier for commercial,
practitioner or physician assistant Medicare Advantage and Medicaid*
Step 4. Refer to CDC ICD-10-CM Official
Coding Guidelines

*HHS is exercising enforcement discretion and waiving

penalties of HIPAA during the COVID-19 emergency
period.
Medicaid* state specific rules for modifiers and
*Subject to state law requirements.
POS apply.

6 © 2020 United HealthCare Services, Inc.

 Telehealth Scenario 5: New patient visit with a provider who uses an audio-video or
audio-only telecommunications system for evaluating need for COVID-19 testing.

Patient Scenario Visit Billing

New patient* presents for a telehealth visit • Scheduled or same day telehealth visit with Step 1. Use appropriate Office Visit E/M
using HIPAA compliant or non–HIPAA- a new patient code (99201-99205)
compliant audio-video or audio-only technology • Use of HIPAA-compliant or non-HIPAA- Step 2. Use place of service that would have
for evaluating need for COVID-19 testing. compliant audio-video or audio-only been reported had the service been
technology, such as FaceTime or Skype* furnished in person (11, 20, 22, 23)
• Care is delivered by a physician, nurse Step 3. Use 95 modifier for commercial,
practitioner or physician assistant Medicare Advantage and Medicaid*
Step 4. Refer to CDC ICD-10-CM Official
Coding Guidelines

*HHS his exercising enforcement discretion and

waiving penalties of HIPAA during the COVID-19
emergency period.
*Subject to state law requirements. Medicaid* state-specific rules for modifiers and
POS apply.

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 Electronic Visit (e-visit) Scenario 1: Communication between an established patient and
their provider through an online patient portal for COVID-19 or non-COVID-19 related care.

Patient Scenario Visit Billing

Established patient sends message • Patient initiates an e-visit on an issue Step 1. Use appropriate CPT code (99421-99423)
(e-visit) through the online patient through the provider’s online patient Step 2. Use appropriate Place of Service (11, 20, 22, 23)
portal or some other secure portal to a physician, nurse
platform (i.e., MyChart). practitioner or physician assistant Step 3. No modifiers are required for commercial, Medicare
Advantage or Medicaid
Step 4. Refer to CDC ICD-10-CM Official Coding Guidelines

Established patient sends message • Patient initiates an e-visit on an issue Step 1. Use appropriate HCPCS code (G2061-G2063)
(e-visit) through the online patient through the provider’s online patient Step 2. Use appropriate Place of Service (11, 20, 22, 23)
portal or some other secure portal to a non-qualified physician
platform (i.e., MyChart). (physical, occupational and/or Step 3. No modifiers are required for commercial, Medicare
speech therapist) Advantage or Medicaid
Step 4. Refer to CDC ICD-10-CM Official Coding Guidelines

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 Virtual Check-In Scenario 1: A brief check-in with the provider using audio-only with
established patient for COVID-19 or non-COVID-19 related care.

Patient Scenario Visit Billing

Established patient connects for • Patient initiates a phone call with physician, Step 1. Use appropriate HCPCS code (G2012)
a brief check-in by audio only nurse practitioner or physician assistant Step 2. Use appropriate Place of Service (11, 20, 22, 23)
(virtual check-in). • Issue is not related to a medical visit within Step 3. No modifiers are required for commercial, Medicare
the previous seven days and not resulting in Advantage or Medicaid
a medical visit within the next 24 hours (or
soonest appointment available) Step 4. Refer to CDC ICD-10-CM Official Coding Guidelines

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 Virtual Check-In Scenario 2: A brief check-in with the provider using a recorded video
and/or images submitted by established patient for COVID-19 or non-COVID-19 related care.

Patient Scenario Visit Billing

Established patient sends • Patient sends a picture for evaluation Step 1. Use appropriate HCPCS code (G2010)
picture for evaluation using a to a physician, nurse practitioner or Step 2. Use appropriate Place of Service (11, 20, 22, 23)
brief check-in (virtual check-in). physician assistant
Step 3. No modifiers are required for commercial, Medicare
• Issue is not related to a medical visit within Advantage or Medicaid
the previous seven days and not resulting in
a medical visit within the next 24 hours (or Step 4. Refer to CDC ICD-10-CM Official Coding Guidelines
soonest appointment available).

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 Resources

• Find the latest UnitedHealthcare COVID-19 related resources at UHCprovider.com/covid19.

• Learn more about our reimbursement policies at UHCprovider.com/policies.

• For the most recent updates on COVID-19, visit the CDC and World Health Organization.

Information provided by the American Medical Association does not dictate payer reimbursement policy, and does not substitute
for the professional judgement of the practitioner performing a procedure, w ho remains responsible for correct coding.

11 PCA-1-20-00905-Clinical- FLY R_04072020 11:43 am EST © 2020 United HealthCare Services, Inc.