Skip to navigation Skip to content Skip to footer
Welcome UCare Providers

COVID-19 Information For Providers

Telehealth, Telemedicine and Technology Based Services

All information contained on this page is applicable only during the declared pandemic time period or other time frames specified below. In the event of any conflict or inconsistency between the information contained on this page and the contents of the UCare Provider Manual, the information on this page shall control during the identified time frame.

PAGE LAST UPDATED JULY 13, 2022

Recent Changes The Weeks of July 4 and July 11:

  • July 13, 2022 – The Eligible Telehealth Services – UCare Medicare Plans and Individual & Family Plans Products section was updated.
  • July 13, 2022 – The Eligible Telehealth Services, Billing and Payment Guidelines for COVID-Related Services – UCare State and Public Programs section was updated.

Eliminating 99201 as a Telehealth Eligible Service

Effective Jan. 1, 2021, 99201 has been deleted and will no longer be an eligible service.

Providers Working from Home – All UCare Products

Effective March 1, 2020, and through the COVID-19 public health emergency, if an eligible provider is furnishing telehealth eligible services from home due to COVID-19 restrictions or for convenience after usual office hours, the address submitted on the claim should be the same as the one the provider customarily uses when submitting claims to UCare. If the provider is performing services from a home-based office that has been enrolled with UCare, then the home-based office address should be submitted on the claim.

Eligible Telehealth Services – UCare Medicare Plans and Individual & Family Plans Products

Eligible Telehealth Providers - Medicare and Individual and Family Plans Products

UCare will follow current Telehealth guidelines, as well as the temporary CMS Guidance published March 17, 2020 - https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. This includes expanding the definition of originating site to include professional services furnished in all eligible health care settings, and in the patient’s residence. In addition, UCare will follow the temporary guidelines expanding the technology that can be used to furnish an eligible telehealth service.

Effective for claims with a date of service of March 1, 2020, and until the COVID-19 national public health emergency is suspended, the list of providers who are eligible to provide services via telehealth is expanded to include all providers who are eligible to bill Medicare for their services, including, but not limited to physical therapists, occupational therapists and speech language pathologists.

Telehealth Eligible Services

It is UCare’s intent to follow CMS guidelines for our Medicare and Individual and Family Plans products. UCare will add, delete and terminate the use of temporarily available codes for COVID-19 during the national public health emergency based on CMS’ notification and effective dates. The most current version of CMS' telehealth eligible list can be found here.

Additional Updates/Clarification

  • Subsequent Nursing Home Visits - The frequency changed from once every 30 days via telehealth to once visit every 14 days.
  • Direct Supervision by Interactive Telecommunications Technology - When required, direct supervision may be provided using real-time, interactive audio and video technology through the later of the end of the calendar year in which the public health emergency ends or Dec. 31, 2021.
  • Appropriate Use of Telehealth Services - Telehealth rules do not apply when the patient and provider are in the same location even if audio/video technology assists in furnishing the service.

Audio-Only Technology

Effective March 1, 2020, and through the COVID-19 public health emergency, CMS defined those telehealth-eligible services that can be furnished without a visual component. Refer to the link above.

Billing and Payment Guidelines for Eligible Telehealth Services – UCare Medicare Plans, Individual & Family Plans Products and State Public Programs Products

Effective for claims with a date of service of March 1, 2020, and until the COVID-19 national public health emergency is suspended, the following guidelines will be temporarily implemented for all telehealth-eligible services:

  • Append the -95 modifier when submitting telehealth eligible services to UCare;
  • Submit telehealth eligible services with the place of service that would have been billed had the service been furnished face-to-face;
  • UCare will accept Place of Service (POS) 02 or 10

- Place of Service 10: Telehealth in a patient's home (effective 1/1/2022-for all products)

- Place of Service 02: (Telehealth provided other than in a patient's home)

  • If Place of Service 02 or 10 are submitted, payment will be based on the Medicare facility allowed amount; and
  • When providing eligible telehealth Evaluation and Management services via telehealth select the level of service based on medical decision-making or time.
  • Telephone calls (CPT codes 99441, 99442 and 99443) have been added to the list of telehealth-eligible services, and the pricing of these services will be updated to the same amount as CPT codes 99212, 99213 and 99214, respectively. Telephone calls should be used when an E/M service is furnished but no video component of telehealth was used.

Rural Health Clinics (RHC) UCare Medicare products, and MSHO Products

RHC Claims for Telehealth Services starting July 1, 2020

  • Submit telehealth using revenue code 052X;
  • Use HCPSC code G2025; and
  • Use of modifier -95 is optional. Claims should not be submitted with modifier –CG modifier.

Source: MLN Matters SE20016 Revised

Rural Health Clinics (RHC) State Public Programs

RHC claims for Audio only Telehealth Services

  • Use CPT Code 99441, 99442 or 99443
  • Use Place of service 10
  • Use Modifier 95

Telephonic telehealth providers: You may provide and bill services via telehealth under Telephonic Telemedicine Provider Assurance Statement (DHS-6806A) only through May 31, 2022. Do not bill place of service 02. Continue to bill as usual (the same way as services delivered in person) and use modifier 95 to indicate you provided the service via audio only (telephonic).

Providers who receive encounter payments: Effective Mar. 19, 2020, Indian Health Service, tribal 638 clinic, Federally Qualified Health Center and Rural Health Clinic telehealth services (including telephonic) will be included for the purposes of the face-to-face encounter payment methodology. Any service when provided face-to-face that would generate an encounter if performed in person will continue to generate an encounter if provided via telehealth, including telephone and televideo, as long as it meets all applicable telehealth requirements.

Federally Qualified Health Centers (FQHC) Medicare Plans, Individual & Family Plans & MSHO Products

FQHC Claims for Telehealth Services starting July 1, 2020

  • Submit telehealth using revenue code 052X;
  • Use HCPCS code G2025; and
  • Append modifier –CG to the claim. Modifier -95 is optional.

Federally Qualified Health Centers (FQHC)

FQHC Claims for Telehealth Services starting July 1, 2020

  • Submit telehealth using revenue code 052X;
  • Use HCPSC code G2025; and
  • Append modifier -CG to the claim. Modifier -95 is optional.

Federally Qualified Health Centers (FQHC) State Public Programs

  • Use CPT Code 99441, 99442 or 99443
  • Use Place of service 10
  • Use Modifier 95

Billing Other Technology-Based Services – UCare Medicare Plans and Individual & Family Plans Products

In addition to telehealth services there are other technology-based services that providers may use.

Effective for services starting March 1, 2020, and until the COVID-19 national public health emergency is suspended, the following services are eligible for payment:

 category cpt/hcpcs code narrative description additional information
 Virtual Visits G2010 Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related Evaluation and Management (E/M) service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. Effective March 1, 2020, and through COVID-19 public health emergency virtual visits can be to new and established patients.
 Virtual Visits G2012 Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion. Effective March 1, 2020, and through COVID-19 public health emergency virtual visits can be to new and established patients.
 E-Visits 99421
99422
99423
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days.
 
 E-Visits Use these codes for claims with a dates of service through 12/31/2020

G2061
G2062
G2063

Effective for claims with a date of service 01/01/2021 and thereafter, claims should be submitted using the following codes:

98970
98971
98972

Qualified nonphysician health care professional online assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days.


 

Qualified nonphysician health care professional online assessment and management service, for an established patient, for up to 7 days, cumulative time during the 7 days. 

 
 Telephone Assessments 98966
98967
98968
Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment.  

Billing for Services Provided in an Outpatient Facility – UCare Medicare Plans and Individual & Family Plans Products

Effective for claims with a date of service of March 1, 2020, and until the national public health emergency is suspended, when an eligible outpatient provider employed by the hospital furnishes telehealth eligible services (e.g., physical therapy, occupational therapy, speech language therapy), bill the services as you normally would, and append the -95 modifier to the telehealth eligible service(s) provided.

Facility Telehealth Visits - UCare Medicare Plans and Individual & Family Plans Products

Until the COVID-19 public health emergency is suspended, the service limitations applied to the telehealth services listed below will no longer be applicable:

  • A subsequent inpatient visit (99231-99233) can be furnished via telehealth, without the limitation that the telehealth visit occurs only once every three days;
  • A subsequent skilled nursing facility visit (99307-99310) can be furnished via telehealth, without the limitation that the telehealth visit is once every 30 days; and
  • Critical care consult codes (G0508-G0509) may be furnished by telehealth beyond the once per day limitation.

Critical Access Hospitals (CAH) Method II Distant Site Telehealth Services – UCare Medicare Plans and Individual & Family Plans Products

The requirements for CAH Method II providers have not changed. When distant site services are billed CAH method II providers on an institutional claim, the -GT modifier should be appended to services performed via telehealth.

Eligible Telehealth Services, Billing and Payment Guidelines for COVID-Related Services – UCare State Public Programs

UCare follows DHS Telehealth guidelines related to eligible provider and services as outlined in the following links:

DHS Coronavirus (COVID-19) Information

Refer to the above link for a complete up-to-date outline of coverage and payment requirements.

Telehealth is the delivery of health care services or consultations through the use of real time, two-way interactive audio and visual communications. Telehealth provides or supports health care delivery and facilitates the assessment, diagnosis, consultation, treatment education and care management of a patient’s health care while the patient is at originating site and the licensed health care provider is at a distant site. Providers providing health care services by telehealth will be held to the same standards and conduct as providers for in-person health care services.

Telehealth includes:

  • Secure video conferencing
  • Store-and-forward technology
  • Audio-only communication between the health care provider and the patient (until July 1, 2023)

Store-and-forward technology
Store-and-forward is the asynchronous electronic transfer or transmission of a patient’s medical information or data from the originating site to a distant site for purposes of diagnostic and therapeutic assistance in the care of the patient. Medical information may include, but is not limited to, video clips, still images, X-rays, MRIs, EKGs, laboratory results, audio clips and text. The physician at the distant site reviews the case without the patient being present. Store-and-forward substitutes for an interactive encounter with the patient present; the patient is not present in real-time.

Audio only
Audio only is the delivery of health care services or consultations through telephone communication while the patient is at one site and the qualified health care provider is at a distant site.

Distant site
Site at which the health care provider is located while providing health care services or consultations by means of telehealth, which can include the provider’s home.

Originating site
The site at which the member is located at the time health care services are provided to them by means of telehealth, which can include the member’s home. For purposes of store-and-forward technology, the originating site also means the location at which the health care provider transfers or transmits information to the distant site.

Equipment
Specific telecommunications equipment is not required as a condition of coverage as long as the health care provider uses equipment that complies with current industry interoperable standards and with the standards required under the Federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191. A health care provider may not require a member to pay for a specific communication technology or application.

Eligible Providers
Providers must self-attest that they meet all of the conditions of the Minnesota Health Care Programs (MHCP) telehealth policy by completing and submitting a Telehealth Provider Assurance Statement (DHS-6806) (PDF) to be eligible for reimbursement.

MHCP covers medically necessary services and consultations delivered by a health care provider through telehealth. A health care provider means a health care professional who is licensed or registered by the state to perform health care services within the provider’s scope of practice according to state law.

The form should be faxed to UCare at 612-676-6501--ATTN: CLAIMS SUPPORT.

Covered Services
MHCP programs will cover telehealth services in the same manner as any other benefits covered through the programs. Coverage will not be limited on the basis of geography or location. Out-of-state coverage policy applies to services provided via telehealth.

List of telehealth services
The CPT and HCPC codes that describe a telehealth service are generally the same codes that describe an encounter when the health care provider and patient are at the same site. Examples of covered telehealth services include, but are not limited to, the following:

  • Consultations
  • Telehealth consults: emergency department or initial inpatient care
  • Subsequent hospital care services
  • Subsequent nursing facility care services
  • End-stage renal disease services
  • Individual and group medical nutrition therapy
  • Individual and group diabetes self-management training with a minimum of one hour of in-person instruction to be furnished in the initial year training period to ensure effective injection training
  • Smoking cessation
  • Alcohol and substance abuse (other than tobacco) structured assessment and intervention services

Audio only (until July 1, 2023)
Audio-only communication will be covered if:

  • There is a scheduled appointment and the standard of care for that particular service can be met through the use of audio-only communication.
  • Substance use disorder (SUD) treatment services and mental health services delivered without a scheduled appointment when initiated by the member while in an emergency or crisis situation and a scheduled appointment was not possible due to the need of an immediate response.

Two-way interactive video consultation in an emergency department (ED)
Two-way interactive video consultation may be billed when no physician is in the ED and the nursing staff is caring for the patient at the originating site. The ED physician at the distant site bills the ED CPT codes with place of service 02. Nursing services at the originating site would be included in the ED facility code. If the ED physician requests the opinion or advice of a specialty physician at a "hub" site, the ED physician bills the ED CPT codes and the consulting physician bills the consultation E/M code with place of service 02.

Noncovered Services
Telehealth does not include:

  • Communication between health care provider and a patient that consists solely of an email or facsimile.
  • Electronic connections that are not conducted over a secure encrypted website as specified by the Health Insurance Portability and Accountability Act of 1996 Privacy and Security rules
  • Prescription renewal
  • Scheduling a test or appointment
  • Clarification of issues from a previous visit
  • Reporting test results
  • Nonclinical communication

Authorization Requirements
Prior authorization is required for health care services delivered through telehealth if prior authorization is required before the delivery of the same service through in-person contact.

Billing
Providers who have an approved Telehealth Provider Assurance Statement (DHS-6806) (PDF) on file with MHCP who submit professional claims for services via telehealth should use claim format 837P (professional), CPT or HCPCS codes that describes the services rendered and with a required place of service 02 or new place of service 10 for services via telehealth. Include the 93 modifier when billing for services provided via audio only (telephone communication).

  • Place of service 02 newly defined: Telehealth provided other than the patient’s home. The location where health services and health-related services are provided or received through telecommunication technology. The patient is not located in their home when receiving health services or health-related services through telecommunication technology.
  • Place of service 10: Telehealth provided in patient’s home. The location where health services and health-related services are provided or received through telecommunication technology. The patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health-related services through telecommunication technology.
  • Modifier 93 Audio only: Synchronous telehealth service rendered via telephone or other real-time interactive audio-only telecommunications system. MHCP requires modifier 93 when audio-only telehealth is used.

Outpatient facilities (Ambulatory Payment Classifications or Ambulatory Surgical Center claims) will continue to use telehealth modifiers on their claims.

Providers who service SUD H2035/HQ on type of bill 89X should continue to use telehealth modifiers on their claims.

MHCP will not reimburse claims for providers who have not submitted DHS-6806 after May 31, 2022. See changes after May 31, 2022, in the Coronavirus (COVID-19) section of the MHCP Provider Manual.

Documentation
Providers must have documentation of services provided and must have followed all clinical standards to bill for telehealth or telephonic telehealth.
As a condition of payment, a licensed health care provider must document each occurrence of a health service delivered through telehealth to a medical assistance enrollee. Health care service records for services delivered through telehealth must meet the requirements set forth in Minnesota Rules, 9505.2175, subparts 1 and 2, and must document:

  • the type of service delivered through telehealth;
  • the time the service began and the time the service ended, including an a.m. and p.m. designation;
  • the health care provider's basis for determining that telehealth is an appropriate and effective means for delivering the service to the enrollee; • the mode of transmission used to deliver the service through telehealth and records evidencing that a particular mode of transmission was utilized;
  • the location of the originating site and the distant site;
  • if the claim for payment is based on a physician's consultation with another physician through telehealth, the written opinion from the consulting physician providing the telehealth consultation; and • compliance with the criteria attested to by the health care provider according to paragraph (b).

Legal References
Minnesota Statutes, 256B.0625, subdivision 3b (Telehealth Services)

Waiver of 3-Day Service Limits – UCare State Public Programs
Effective for dates of service on and after March 19, 2020, and through the COVID-19 public health emergency the current limitation of three telemedicine encounters per week is temporarily suspended

Return to COVID-19 Information for Providers Page