Wiki Help!!!! Telehealth denials

[CDPulmonary]

We need HELP! United Health Commercial member had a telephone only visit with our physician in January 2022. We used CPT code G2012 only, as we used all of 2021. Our claim has been denied multiple times, and United is telling us that we need to use a primary procedure code in addition to G2012 for this visit. We're not sure how to proceed What other codes do should we use?????????

 

[carlystur]

Maybe they mean 99441-99443?

 

[trarut]

Have you reviewed the UHC Telehealth Service page? They link to multiple documents there and have a section at the bottom of the page for billing guidance. If that does not help, someone from your office need to call Provider Services and ask them for more information about the denial, if you haven't already done so. This could be related to a specific plan exclusion. Has this patient had telehealth services with your office before that were paid? If so, was there something different about that one compared to this one?

Telehealth

UnitedHealthcare has expanded its policies around telehealth services during the COVID-19 health emergency. Check back often for updates

www.uhcprovider.com

 

[csperoni]

The link provided by @trarut is probably your best bet.
For telehealth and all it's variances, there is one set of rules from Medicare. Some carriers simply stated: "We'll follow whatever Medicare is doing." Some came up with their own codes/POS/modifiers/policies and sometimes they even vary based on the type of plan from the same carrier. You must follow the carrier guidance.
My large healthcare organization built all the rules/regulations for various carriers into the revenue system. This way, the claim is entered with Medicare rules, and if the carrier wants something else, the system will adjust. To be honest, at the beginning of the pandemic, I was personally keeping up with all the guidelines. Now, as long as I know the Medicare guideline, that is all I need to enter.