For dates of service on or after Nov. 1, 2019, the National Drug Code (NDC) policy for UnitedHealthcare Medicare Advantage plans, including all UnitedHealthcare Dual Complete plans, will be revised for drug-related codes in outpatient facilities.
With this policy change, care providers who are contracted with us who submit claims for drug-related Healthcare Common Procedure Coding System (HCPCS) and CPT codes in an outpatient facility will be required to include the following information on the claim,
• A valid NDC number
• Quantity
• A unit of measure
If the required information isn’t included, the claim may be denied. The NDC requirement will apply to all claims submitted on the CMS-1500, Electronic Data Interface (EDI) 837p, CMS UB-04 and EDI 837i claim forms.
Reason for Changes:
As the industry standard identifier for drugs, NDCs provide full transparency to the medication administered. They accurately identify the manufacturer, drug name, dosage, strength, package size and quantity.
Will keep you posted list of CPT codes at the earliest
Reference: https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2019/network-bulletin/August-Network-Bulletin-2019.pdf#page=27
Click here for Revised Moh's Surgery Guidelines
Blogger Widget
Popular Posts
-
Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbur...
-
An OPPS payment status indicator is assigned to every HCPCS code. The status indicator identifies whether the service described by the H...
-
Claim Adjustment Reason Codes (CARC) CO-22 or PR-22 This care may be covered by another payer per coordination of benefits. CO-19 This is...
-
Therapeutic activities are considered medically necessary for patients needing a broad range of rehabilitative techniques that involve ...
-
Health benefit payers, including Medicare, are limited to use of those internal and external code sets identified in the implementation gui...
-
Mohs surgery, also known as chemosurgery, created by a general surgeon, Dr. Frederic E. Mohs, is performed to remove complex or ill-defi...
-
This procedure is medically necessary only when it requires the professional skills of a therapist, is designed to address specific ne...
-
Ambulance transportation is a covered service when the patient’s condition is such that the use of any other method of transportation would...
-
CIGNA will adopt a common time frame for health care professionals to follow for submitting claims to CIGNA. Except where state law requir...
-
Sentinel lymph node identification and biopsy typically involves a multidisciplinary approach. A nuclear medicine procedure called lymph...
