On May 1, UnitedHealthcare made nine changes to its reimbursement policies for its commercial, individual and family, and Medicare Advantage plans. Some of the changes go into effect June 1, while others will begin August 1.
Here are nine UnitedHealthcare reimbursement changes happening in the coming months:
Commercial plans:
Molecular pathology policy, professional and facility: The new policy will no longer require submission of a unique test ID obtained through the Genetic Test Registry, but the policy will require the submission of a DEX-Z code.
Anatomical modifier requirement policy, professional: United will align with CMS to provide correct coding requirements for percutaneous coronary intervention procedures.
Age-based codes policy, professional: United will align with correct age-appropriate code submission, and procedure codes for members outside the appropriate age range for the codes will be ineligible for reimbursement.
Individual and family plans:
Anatomical modifier requirement policy, professional: United will align with CMS to provide correct coding requirements for percutaneous coronary intervention procedures.
Device and skin substitute policy, facility: Appropriate device codes must be submitted on the same claim for the same date of service.
Medicare Advantage plans:
Ordering and referring provider NPI CMS requirement: The ordering or referring provider must be identified on all claims initiated by orders or referrals.
Observation and discharge policy, professional: Observation and discharge coding and guidelines will change based on CMS and American Medical Association guidance.
Evaluation and management policy, professional: Reimbursement policies will align with CMS and the American Medical Association.
Coronary anatomic modifier: Claims billed for percutaneous coronary interventions must include appropriate modifiers to identify which specific vessel is undergoing procedure.
Source URL: https://www.beckersasc.com/asc-news/9-changes-to-unitedhealthcares-reimbursement-policies-for-may.html