Anthem BC has revised their policy concerning modifiers that are required on outpatient physical, occupational and speech therapy claims. Failure to append the applicable modifier will result in nonpayment of your claim. Anthem BC services the following states: California Colorado Connecticut Georgia Indiana Kentucky Maine Missouri New Hampshire Nevada New York Ohio Virginia Wisconsin To access the policy, click I hope you found this article helpful. Thank you for being a Gold Member!

I receive many questions regarding how to locate outpatient therapy policies for UnitedHealthcare (UHC) and OptumHealth Care Solutions (Optum). In this article, I will provide links to the most common outpatient physical, occupational and speech therapy policies for UHC and Optum. UHC Reimbursement Policies for Outpatient Therapy Services Optum Reimbursement Policies for Outpatient Therapy Services I hope you found this article helpful and you utilize all of the outpatient therapy policies in this article. Thank you for being a Gold Member!

Palmetto GBA has announced that some skilled nursing facility (SNF) type of bills (TOB) 22X and 23X and Critical Access Hospital (CAH) TOB 85x with dates of service January 1 through April 11, 2021, processed prior to April 12, 2021, did not have the Multiple Procedure Payment Reduction (MPPR) applied on them. The system was updated on April 12, 2021, when the fix was installed. These TOBs with Revenue Code 042X, 043X or 044X present with more than 1 units or Revenue Code 042X, 043X or 044X present on more than one line with the same line item date of service, are

UnitedHealthcare Community Plan has published 2 Reimbursement Policies, one for providers who submit claims on a 1500-claim form (Professional) and one for providers who submit claims on a UB-04 claim form (Facility). The policies list which CPT codes are and are not covered by the different state’s Medicaid program. To access the policy for providers who submit claims on a 1500-claim form, click To access the policy for providers who submit claims on a UB-04 claim form, click I hope you found this article helpful to your practice or organization. Thank you for being a Gold Member!

UnitedHealthcare Community Plan has published a new reimbursement policy regarding ICD-10 diagnosis coding on a UB-04 claim form. The states that are impacted by this new policy include the following: Arizona California Florida Hawaii Maryland Michigan Mississippi Missouri Nebraska New Jersey New York Ohio Pennsylvania Texas Virginia Washington Wisconsin The effective date is June 1, 2021 for all of the above states except for New York and Texas. The effective date for New York and Texas is July 1, 2021. This new policy will deny claims where an inappropriate diagnosis is in Box 67 on a UB-04 claim form or

UnitedHealthcare Oxford has published a new reimbursement policy on National Correct Coding Initiative (NCCI) edits that is applicable for therapy providers who submit claims on a 1500-claim form. The effective date of this new policy is I hope you found this information helpful. Thank you for being a Gold Member!

UnitedHealthcare Community plan has revised their Speech Generating Devices Coverage Determination Guideline with an effective date of July 1, 2021. To access the revised guideline, click

UnitedHealthcare (UHC) Community Plan has revised their Cognitive Rehabilitation medical policy for the states of Nebraska and Tennessee. To access the revised policy for Nebraska, click I hope you found this information helpful. Thank you for being a Gold Member!