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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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01/03/22

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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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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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

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10/29/21

UHC Medicare Advantage Telehealth Update: October 2021

On October 15, 2021, UnitedHealthcare (UHC) I hope you found this article 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.

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10/04/21

UHC Oxford Revises PT/OT Clinical Policy

UnitedHealthcare (UHC) Oxford has revised their outpatient physical and occupational therapy clinical policy. QuestionWhat is the effective date of the revised policy? Answer QuestionCan you provide a summary of the changes in this revised policy? Answer QuestionAre there CPT codes that can’t be billed by an Occupational Therapist? Answer QuestionAre there any exceptions to this policy? Answer QuestionWhere can I access the revised policy? Answer I hope you found this article helpful to your practice. 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

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10/04/21

UHC Individual Exchange Policy Update

UnitedHealthcare (UHC) Individual Exchange has a revised policy regarding Modifiers 96 and 97 that may have an impact on outpatient physical, occupational and speech therapy services. QuestionWhat is the policy title? Answer QuestionWhat are the changes to this policy? Answer QuestionWhat is the effective date of the revised policy? Answer QuestionHow can I access this update? 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

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07/21/21

UHC Advantage Telehealth Update

On July 19, 2021, UnitedHealthcare (UHC) Medicare Advantage announced their continued expansion of telehealth access, including temporarily waiving the Centers for Medicare & Medicaid Services (CMS) originating site requirements. UHC will extend the expansion of telehealth access for in-network and out-of-network providers I hope you found this article helpful. Thank you for being a Gold Member!

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