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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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09/04/23

UnitedHealthcare Eliminates Prior Authorization for Some Outpatient Therapy Services

UnitedHealthcare (UHC) has published a list of CPT codes billed by physical and occupational therapists that will no longer require prior authorization. Continue reading below to find out which CPT codes are being removed from requiring prior authorization for the various UHC plans.

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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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08/29/22

Cigna Will Not Reimburse for More Than 4 Units

Cigna has announced a new payment policy that has implications for outpatient physical and occupational therapy services. Effective with dates of services on and after

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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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