Skip to main content

In a major win for the profession and patients, UnitedHealthcare has become the first of the country's largest private health insurers to adopt a permanent telehealth policy that includes PTs. APTA has made educating insurers on the value of permanently covering PT- and PTA-delivered telehealth a central focus of its advocacy efforts.

(Since publication of this article, UHC has shared the list of CPT codes that will be accepted for reimbursement when delivered vial telehealth.)

UnitedHealthcare has updated its Telehealth/Telemedicine Policy, Professional for providers who bill services on a 1500 claim form, to include physical therapists as eligible providers. UHC will cover certain physical, occupational, and speech therapy telehealth services rendered through interactive audio and video technology.

Services submitted on the 1500 form should include:

  • Code(s) from the list of specific physical, occupational, and speech therapy telehealth services (see the "Telehealth-Eligible Services Code List" in the attachments section of the policy), and;
  • The appropriate place-of-service code 02 in Box 24B.

All physical therapy telehealth visits must be performed using live, interactive video conferencing that involves the presence of both parties at the same time, as well as a communication link between them that allows for real-time audio and visual interaction. Emailing recorded exercise videos and discussing or reviewing by phone is not reimbursable.

While most insurers currently allow PTs to be reimbursed for services delivered via telehealth, those allowances are limited to the duration of the COVID-19 public health emergency, with a few exceptions.

The UHC decision is likely to affect more providers and patients than any previous insurer's permanent telehealth allowance: recent analyses estimate that UHC has a 14.1% share of the entire private health insurance market in the U.S.

Alice Bell, APTA senior payment specialist, says the UHC decision validates what APTA has been telling insurers even before the pandemic — that telehealth is not just viable but an effective way for some PT services to be delivered.

"Clearly, the data being collected by insurers is bearing out the idea that PTs and PTAs can engage in telehealth and increase patient access to needed services," Bell said. "We applaud United Healthcare's recognition of the success of telehealth during the pandemic and hope that other insurers will follow its lead." 


You Might Also Like...

Perspective

One-Size-Fits-All Insurance Is Shortchanging Older Athletes

Jan 25, 2022

Health insurance coverage for outpatient musculoskeletal rehabilitation disregards variability in prior level of function, rehabilitation progress, and

Open Access

Advocating for Coverage: Template Letters

Jan 14, 2022

Access a variety of template letters you and your patients can use when your patient is denied coverage, the services approved are inadequate, or care

Members Only

Payment and Regulatory Update - Dec. 1, 2021

Dec 1, 2021

Dec. 1, 2021: Topics discussed: Medicare Physician Fee Schedule, Vaccine Mandates, Commercial Payer Updates