UnitedHealthcare and Optum Behavioral Health psychotherapy coverage: codes, telehealth and limits
By Javier Alvarez · Updated · 1 min read
1 row: UnitedHealthcare / Optum Behavioral Health. Public policy, not the member's benefits.
UnitedHealthcare and Optum Behavioral Health
Optum telemental health reimbursement policy (commercial) and telehealth billing quick reference · All states
| 90785 | Listed [1] |
|---|---|
| 90791 | Listed [1] |
| 90832 | Listed [1] |
| 90834 | Listed [1] |
| 90837 | Listed [1] |
| 90846 | Listed [1] |
| 90847 | Listed [1] |
| 90853 | Listed [1] |
| Telehealth POS | Every behavioral health telehealth claim needs POS 02 or POS 10, effective Nov. 1, 2023, across commercial, Medicare Advantage and Medicaid/Community Plan lines. Use POS 10 when the member is at home and POS 02 when not. POS is the member's location, not the provider's. POS 11 is not an appropriate telehealth place of service. [2] |
| Telehealth modifier | Modifiers 93, 95 and GT are not required to identify telehealth but are accepted as informational with eligible services and POS 02 or 10. A claim with only a telehealth modifier and no POS 02 or 10 is not reimbursed. Audio-only is paid only with modifier 93 and POS 02 or 10, when mandated by state regulation or covered by the member's plan; the policy says to use modifier FQ only for FQHC or rural health clinic services. [1][2] |
| Telehealth rules | The commercial policy covers live, interactive audio and video (synchronous only). The clinician must hold a valid license in the state where the member is receiving services and work within the scope of that license. The policy applies to participating and non-participating providers when the plan has out-of-network coverage. The visit should be documented as audio-video. [1] |
| Visit limits | The eligible telehealth code list is described as not exhaustive. Payment may also be subject to benefit plan provisions and prior authorization requirements. [1][2] |
What UnitedHealthcare and Optum Behavioral Health's documents say
The table above has every field we found for UnitedHealthcare and Optum Behavioral Health, with numbered sources. In short:
- Visit limits. The eligible telehealth code list is described as not exhaustive. Payment may also be subject to benefit plan provisions and prior authorization requirements.
- Telehealth rules. The commercial policy covers live, interactive audio and video (synchronous only). The clinician must hold a valid license in the state where the member is receiving services and work within the scope of that license. The policy applies to participating and non-participating providers when the plan has out-of-network coverage. The visit should be documented as audio-video.
- Telehealth POS. Every behavioral health telehealth claim needs POS 02 or POS 10, effective Nov. 1, 2023, across commercial, Medicare Advantage and Medicaid/Community Plan lines. Use POS 10 when the member is at home and POS 02 when not. POS is the member's location, not the provider's. POS 11 is not an appropriate telehealth place of service.
- Codes. 90785, 90791, 90832, 90834, 90837, 90846, 90847 and 90853 are listed.
Psychotherapy coverage at other national payers
Medicare, Cigna and Evernorth Behavioral Health and TRICARE.
Check UnitedHealthcare and Optum Behavioral Health's claim against the row
Before the claim goes out, compare it with the row above: the code matches the session length you documented, the place of service and modifier fit a video or audio-only visit, and the rendering clinician's license is one the payer enrolls. The psychotherapy table compares UnitedHealthcare / Optum Behavioral Health with every other payer we checked.