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05/06/24

UnitedHealthcare Introduces a Diagnosis Code Requirement Policy

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

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07/26/23

UnitedHealthcare Updates Outpatient Therapy Medical Policy: August 2023

UnitedHealthcare (UHC) has once again revised their Habilitation and Rehabilitation Therapy (Occupational, Physical and Speech) revised medical policy with an effective date of August 1, 2023. The revised policy impacts all UHC Commercial plans and UHC Oxford. The only revision to this revised policy compared to the July 1, 2023 revision is UHC has

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05/01/23

UHC Medicare Advantage June 2023 Reimbursement Update

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:

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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

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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,

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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

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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?

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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

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