UnitedHealthcare (UHC) has announced they have once again extended coverage of outpatient physical, occupational and speech therapy services delivered via telehealth for their Medicare Advantage beneficiaries. UHC will cover all in-network and out-of-network outpatient therapy telehealth services as outlined Thank you for being a Gold Member!

UnitedHealthcare (UHC) Community Plan has issued a revised Speech Language Pathology Services Coverage Determination Guideline (CDG). The effective date of this revised CDG is May 1, 2021 and only applies to the states of Arizona, California, Hawaii, Kansas, Maryland, Michigan, New York, Ohio, Pennsylvania, Rhode Island, Virginia, Washington, and Wisconsin. To access the revised policy, click I hope you found this article helpful. Thank you for being a Gold Member.

Effective with dates of service on or after 9/1/2020, the Outpatient Hospital Correct Coding Initiative (CCI) Editing policy will apply to all network and non-network hospitals. In addition, the policy will apply to all outpatient types of bills that are applicable to these edits. Click HERE to read the announcement straight from UnitedHealthcare.

UnitedHealthcare (UHC) has revised several therapy coverage determination guidelines and medical policies related to their UHC Commercial and Affiliate Plans, UHC Exchange Plans, and UHC Community Plan. Continue reading below to access the revised guidelines and medical policies that are applicable to your state. UHC Commercial Medical Policy Update The following coverage determination guideline has been revised and applies to all 50 states. This Coverage Determination Guideline may also be applied to Medicare Advantage plans in certain instances. In the absence of a Medicare National Coverage Determination (NCD), Local Coverage Determination (LCD), or other Medicare coverage guidance, CMS allows a

UnitedHealthcare (UHC) has announced a commercial reimbursement policy update for outpatient physical, occupational and speech therapy services provided in facility settings. This would include any setting that submits claims to UHC on a UB-04 claim form. This policy update will impact UHC Commercial Plans as well as UHC Oxford Health Plans. The new Outpatient Rehabilitation Therapy Services Policy, Facility will be effective for dates of service on and after I hope you found this information helpful. Thank you for being a Gold Member!

On January 1, 2021, outpatient physical, occupational and speech therapy services provided via telehealth for UnitedHealthcare (UHC) commercial plans will be changing and there will be a difference in telehealth coverage between providers who submit claims on a 1500-claim form and providers who submit claims on a UB-04 claim form. QuestionWhat is changing on January 1, 2021 for UHC Commercial plans? Answer QuestionWhat place of service (POS) code is to be used on the claim form for an outpatient therapy visit conducted via telehealth? Answer QuestionWhat is changing on January 1, 2021 for UHC Medicare Advantage plans? Answer

UnitedHealthcare (UHC) has announced that effective January 1, 2021, certain UnitedHealthcare Medicare Advantage and commercial plans will allow certain Centers for Medicare & Medicaid (CMS)-eligible telehealth services when billed with the member’s home as an originating site. For important information on changes to UnitedHealthcare’s commercial Telehealth and Telemedicine Reimbursement Policy as they pertain to outpatient physical, occupational and speech therapy services, click I hope you found this article informative to your practice. Thank you for being a Gold Member!

Physical therapy and/or occupational therapy visits performed by care providers contracted by Optum Physical Health require prior authorization, which includes the plan member’s initial evaluation. In addition, Optum Physical Health has specific clinical and reimbursement policies pertaining to outpatient therapy services that contracted providers must be aware of and adhere to. To access Optum Physical Healths’ clinical and reimbursement policies as they pertain to outpatient therapy services, click I hope you found this information helpful. Thank you for being a Gold Member!