Wiki Audio Only Telehealth Visits

[tilquist3@comcast.net]

Hello,

We are having an issue with UHC not paying for Audio Only Telehealth visits for 2025. We tried billing "Audio Only - 10 minutes" the following ways for a patient who has United Healthcare Commercial plan:
CPT 98012 and no modifier, the claim was rejected.
CPT 99212, modifier 93, the claim was rejected.

UHC Audio Only CPT list does not have 98012 or 99212 listed on it.
I can bill 99212 without a modifier, but how will UHC know that it was an Audio Only visit?

Any help would be appreciated.

 

[jkyles]

See below

Hi there, unfortunately UHC doesn't cover office/outpatient visits performed as by an audio-only connection. They use the CPT Manual's list of audio-only services, which is in Appendix T. It's a bit confusing because the new audio-only E/M codes are not in Appendix T.

From the policy: https://www.uhcprovider.com/content...t/COMM-Telehealth-and-Telemedicine-Policy.pdf

Audio-Only Telehealth

UnitedHealthcare aligns with the AMA and will consider for reimbursement the services included in Appendix T of the CPT code set, which are appropriate for reporting real-time, interactive audio-only Telehealth, when appended with modifier 93, and reported with POS 02 or 10. See the Telehealth Audio-Only Eligible Services Code List in the Attachments section. CPT codes reported with modifier 93 that are not included in Appendix T of the CPT code set will not be eligible for reimbursement.

Covered codes: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/attachments/reimbursement/Telehealth-Audio-Only-Code-List.pdf

 

[tilquist3@comcast.net]

Hi there, unfortunately UHC doesn't cover office/outpatient visits performed as by an audio-only connection. They use the CPT Manual's list of audio-only services, which is in Appendix T. It's a bit confusing because the new audio-only E/M codes are not in Appendix T.

From the policy: https://www.uhcprovider.com/content...t/COMM-Telehealth-and-Telemedicine-Policy.pdf



Covered codes: https://www.uhcprovider.com/content...bursement/Telehealth-Audio-Only-Code-List.pdf

Thank you.

 

[jkyles]

Actually, I need to change my answer. Someone pointed out that Aetna has a contradictory policy: https://www.aapc.com/discuss/threads/telehealth.203632/