Change to NDC Reimbursement Policy for UHC Outpatient Facilities

Change to NDC Reimbursement Policy for UHC Outpatient Facilities

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…

New Molecular Pathology Guidelines

New Molecular Pathology Guidelines

The new Molecular Pathology coding guidelines changes will be effective from dates of service on and after Sept. 1, 2019. American Medical Association (AMA) guidance provides Claim Designation codes in the Molecular Pathology coding guidelines Gene Table that represent specific genes that are being tested. UnitedHealthcare will require care providers to append the AMA Claim…

UHC Revision Non-Physician Health Care Professionals Billing E/M Codes

UHC Revision Non-Physician Health Care Professionals Billing E/M Codes

UnitedHealthcare does not currently reimburse Evaluation and Management (E/M) CPT codes 99201-99499 when submitted by specific nonphysician health care professionals. According to the Centers for Medicare and Medicaid Services (CMS), E/M services are reimbursable to certain non physician practitioners, limited to nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants. Effective in the…

UHC Modifiers Not Reimbursable to Health Care Professionals

UHC Modifiers Not Reimbursable to Health Care Professionals

UnitedHealthcare will not reimburse modifiers H9, HU-HZ, QJ or TR, effective in the second quarter of 2015. The use of the following modifiers indicates that a service has been funded by a county, state or federal agency; therefore, no cost has been incurred requiring reimbursement: H9 Court-ordered HU Funded by child welfare agency HV Funded state addictions agency…

UHC Cardiology Notification Program – Procedures Requiring Notification

UHC Cardiology Notification Program – Procedures Requiring Notification

Notification is required for each of the following procedures in all places of service including inpatient, outpatient, and office-based settings: Diagnostic Catheterization (Effective January 1, 2011) Diagnostic left heart catheterization (ventriculography only): CPT 93452 Combined right and left heart catheterization (ventriculography only): CPT 93453 Coronary Arteriogram (no ventriculography): CPT 93454, CPT 93455 Coronary Arteriogram and…

UHC Preauthorization requirements

UHC Preauthorization requirements

Here we discuss UnitedHealthCare sleep study coverage. Obstructive sleep apnea (OSA) is a treatable form of sleep disordered breathing. OSA affects at least 2% to 4% of the adult population and is increasingly recognized by the public.The presence or absence and severity of OSA must be determined before initiating treatment in order to identify those…