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Wiki Telehealth

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promedbilling

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Hi,

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:

1.CPT 98012 & No Modifier, the claim was rejected.
2.CPT 99212, Modifier 93, the claim was rejected.

UHC Audio Only CPT list, does not have 98012 or 99212 listed on it.
Link for UHC article: https://www.uhcprovider.com/content...bursement/Telehealth-Audio-Only-Code-List.pdf
UHC Replacement Code CPT list, says that 98012 can be billed with 99212.
Link for UHC article: https://www.uhcprovider.com/content...imbursement/COMM-Replacement-Codes-Policy.pdf

I can bill CPT 99212 without a modifier, but how will UHC know that it was an Audio only visit?

Any help would be appreciated.
 
Hi there, someone is having a similar issue, but I didn't realize that UHC has another policy that contradicts their telehealth policy. o_OWhen payers have internal errors trying to code around them won't work. Something in their system is saying "Don't pay these codes under these circumstances." Your choices are submitting an appeal and including Aetna's policies with a clear explanation of the contradiction, or contacting a rep at Aetna and walking them through the problem. Or both.
 
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