Current News

News

06/01/22

UnitedHealthcare Medicare Advantage Updates Therapy Coverage Policy

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

Read More
03/07/22

UHC Revises Negative Pressure Wound Therapy Medical Policy

UnitedHealthcare (UHC) Commercial and UHC Oxford have revised their Negative Pressure Wound Therapy medical policy with an effective date of May 1, 2022. To access the revised policy,

Read More
01/25/22

UHC Oxford Revises MPPR Policy

UnitedHealthcare (UHC) Oxford has revised their Multiple Therapy Procedure Reduction (MTPR) reimbursement policy with an effective date of December 1, 2021. In this policy, UHC Oxford lists the practice expense (PE) relative value unit (RVU) of each applicable CPT code so therapy providers will know which CPT code has the highest PE RVU and thereby will know the first unit of that code will not have their PE RVU decreased by 50%. Providers will then know which other CPT codes billed that day will have their PE RVU decreased by 50%. To access the revised policy, click

Read More
01/03/22

UnitedHealthcare Medicare Advantage to Reduce Payment When Services Provided by an Assistant

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?

Read More
01/03/22

UnitedHealthcare Commercial Updates for January 2022

UnitedHealthcare (UHC) Commercial has updated 2 of their Coverage Determination Guidelines that impact outpatient physical, occupational and speech therapy services as well as habilitative physical, occupational and speech therapy services with an effective date of January 1, 2022. In addition, UHC has issued 1 Reimbursement Policy Update. To access the 3 updated policies, log into your account and then click on the applicable link below. I hope you enjoyed this article. 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

Read More
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

Read More
12/06/21

UnitedHealthcare West Habilitative Services Update

UnitedHealthcare (UHC) has updated and revised their Habilitative Services Benefit Interpretation Policy with an effective date of January 1, 2022. This updated/revised Benefit Interpretation Policy applies to the following states: Oklahoma Oregon Texas Washington To access the Benefit Interpretation Policy, 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 written approval of Gawenda Seminars & Consulting, Inc.

Read More
12/06/21

UnitedHealthcare Medicare Advantage Revises Their Telehealth Policy

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

Read More