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The major change, effective until June 18, permits PTs to be reimbursed for telehealth services using the company's typical billing codes but is subject to state laws and regulations.

The major change, effective until June 18, permits PTs to be reimbursed for telehealth services using the company's typical billing codes but is subject to state laws and regulations.

UnitedHealthcare, the country's largest commercial health insurer, announced a major shift in its coverage policies during the COVID-19 pandemic: Beginning immediately, the payer will reimburse physical therapy delivered via telehealth services. The change is the most wide-ranging payer acknowledgement of PTs as qualified telehealth providers to date, and it moves UHC well past CMS' and a few other payers’ current waivers allowing for limited "e-visit" digital communications between PTs and patients.

The new benefits are set to end on June 18 and are subject to state laws and regulations around telehealth, but, if permissible, they enable PTs, occupational therapists, and speech therapists to provide true telehealth services and use their typical billing codes. Eligible codes will be reimbursed by UHC with a place-of-service code 02 and the 95 modifier.

The UHC change is a significant improvement for PTs. Until now, national private insurers including UHC and Aetna, have been following CMS' lead and allowing only e-visits, a limited form of digital communication restricted to only a portion of codes, and not truly considered telehealth.

While the COVID stimulus package on the horizon allows the U.S. Department of Health and Human Services to apply a waiver permitting PTs to engage in telehealth for Medicare beneficiaries, those waivers are unlikely to happen without a strong advocacy effort from the physical therapy profession — an effort that APTA is facilitating through a template letter to send to CMS that makes the case for the change.

Carmen Elliott, MS, APTA's vice president of payment and practice management, said that the UHC change is big news.

"The fact that the largest insurer in the country has temporarily shifted its reimbursement policies around telehealth is important in terms of patient and provider care and safety during this pandemic," Elliott said. "But it's also a tremendous opportunity for the physical therapy profession to demonstrate its ability to operate effectively in the telehealth space."


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