Article Updated August 13, 2024: UnitedHealthcare (UHC) has announced they are going to require prior authorization for certain outpatient services. In this article, I will answer the following questions:

UnitedHealthcare (UHC) Medicare Advantage (MA) has revised their therapy policy that has implications for skilled nursing facilities, long-term acute care hospitals, and outpatient therapy providers which includes private practices, hospitals, and comprehensive outpatient rehabilitation facilities. The effective date of this revision is August 1, 2024. If you treat UHC MA patients, you need to read this policy. To access the revised policy, click

UnitedHealthcare (UHC)has introduced a comprehensive diagnosis code requirement policy for both professional and facility services. This new policy will combine 3 existing diagnosis policies into this new comprehensive diagnosis policy. The effective date of the new policy is To access this new policy as it applies to UHC Medicare Advantage, click To access this new policy as it applies to UHC Community Plans, click To access this new policy as it applies to UHC Individual Exchange Plans, click

UnitedHealthcare (UHC) Medicare Advantage has a new reimbursement policy that could have an impact on outpatient therapy claims billed on a 1500-claim form as well as the UB-04 claim form. In this article, I will provide the answers to the following questions:

UnitedHealthcare Medicare Advantage has updated their coverage summary for speech generating devices. To access the updated coverage summary for speech generating devices, click

UnitedHealthcare (UHC) Medicare Advantage has updated their OT, PT, and ST Coverage Policy. The effective date of the updated coverage policy is May 4, 2022. To access the updated policy, click

UnitedHealthcare (UHC) has announced they will reduce payment when services are provided in whole or in part by a physical therapist assistant or an occupational therapy assistant to UHC Medicare Advantage beneficiaries. In this article, I will answer the following questions: When is the effective date of the payment reduction? What is the payment reduction? Will this payment reduction apply to outpatient therapy claims submitted on a 1500-claim form? Does this policy apply to out-of-network (OON) providers? Will this payment reduction apply to outpatient therapy claims submitted on a UB-04 claim form? Does this policy apply to UnitedHealthcare Commercial plans?

UnitedHealthcare (UHC) has revised their professional Telehealth/Telemedicine Policy for their UHC Medicare Advantage plans. The effective date for the revised policy is January 1, 2022. This revised policy will not only discuss Place of Service (POS) code 02, but also the new POS code 10 that becomes effective January 1, 2022. To access this information, click I hope you found this article to be informative. 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