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12/06/21

UnitedHealthcare Community Plan December 2021 Update

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

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10/04/21

UHC Community Plan Revises Outpatient Speech, Occupational and Physical Therapy Utilization Review Guidelines

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

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10/04/21

UHC Community Plan Revises SLP Coverage Determination Guideline

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

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09/13/21

UHC Community Plan Revises PT/OT Policy

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.

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09/13/21

UHC Community Plan of New Jersey Update

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!

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06/02/21

UHC Community Plan Implements Inappropriate Primary Diagnosis Policy

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

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05/10/21

UHC Community Plan Medicaid Covered and Non-Covered CPT Codes

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!

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05/10/21

UHC Community Plan Reimbursement Policy Updates

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

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