UnitedHealthcare (UHC) Community Plan has revised their outpatient therapy policy. Summary of changes include the following: To access the revised policy, click

UnitedHealthcare (UHC) Community Plan has issued an Outpatient Physical and Occupational Therapy Coverage Determination Guideline with an effective date of December 1, 2021. This Coverage Determination Guideline only applies to the states of Arizona, California, Hawaii, Kansas, Maryland, Michigan, New York, Ohio, Rhode Island, Virginia, Washington, and Wisconsin; however, this Coverage Determination Guideline has links to Outpatient Physical, Occupational and Speech Therapy Coverage Determination Guidelines for the states of Florida, Indiana, Kentucky, Nebraska, New Jersey and North Carolina. If you practice in one of the above mentioned states, this is definitely an article you want to read and understand. To

UnitedHealthcare (UHC) Community plan has revised their Outpatient Speech, Occupational and Physical Therapy Utilization Review Guidelines. QuestionWhat is the effective date of the revised policy? Answer QuestionWhat state(s) does the revised policy apply to? Answer QuestionWhat are some of the topics discussed in the policy? Answer QuestionHow can I access the policy? Answer I hope you found this article informative and helpful. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior written approval of

UnitedHealthcare (UHC) Community Plan has revised their Speech Language Pathology Services Coverage Determination Guideline. QuestionWhat is the effective date of the revised policy? Answer QuestionWhat state(s) does the revised policy apply to? Answer QuestionWhat are some of the topics discussed in the policy? Answer QuestionHow can I access the revised policy? Answer I hope you found this article informative and helpful. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior written approval of Gawenda

UnitedHealthcare Community Plan has released a revised Coverage Determination Guideline (CDG) for outpatient physical and occupational therapy services for the following states: Arizona California Hawaii Kansas Maryland Michigan New York Ohio Rhode Island Virginia Washington Wisconsin Changes include Required Documentation for the following: Initial Therapy Evaluation/Initial Therapy Visit Requests Request for Continuation of Therapy Visits Progress Reports Re-evaluations Visit Guidelines Signed and Dated Physician Orders To access the revised policy, click I hope you found this information helpful. Thank you for being a Gold Member! All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc.

UHC Community Plan of New Jersey has announced they will be adding CPT codes that are billed by physical therapists, occupational therapists and speech-language pathologists to their list of codes that require Advance Notification and Prior Authorization. To access the revised list, click I hope you found this information helpful. Thank you for being a Gold Member!

UnitedHealthcare (UHC) Community plan has implemented a new inappropriate primary diagnosis policy with an effective date of June 1, 2021. This new policy will deny claims where an inappropriate diagnosis is in box 67 on a UB-04 claim form or its electronic equivalent. This policy is being implemented in 20 states and will impact outpatient physical, occupational and speech therapy services. To access this policy, click

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!