UnitedHealthcare Commercial has updated their coverage determination guideline pertaining to Habilitative Services and Outpatient Rehabilitation Therapy with an effective date of April 1, 2020. In this updated coverage determination guideline, UHC lists certain CPT codes that are only payable as habilitative therapy services when they are billed with one of the habilitative diagnosis codes in the primary position on the claim. In addition, in this coverage determination guideline, UHC lists which ICD-10 diagnosis codes, when listed in the primary position on the claim form, qualify as habilitative therapy services only. In addition, UHC provides which CPT codes are payable for

UnitedHealthcare Medicare Advantage has updated their coverage summary for speech generating devices with an effective date of February 18, 2020. To access the updated clinical policy, click HERE. Thank you for being a Gold Member!

UnitedHealthcare (UHC) has announced they will implement the National Correct Coding Initiative (NCCI) edits to outpatient physical, occupational and speech therapy services effective with dates of service on and after I hope you found this article informative and will assist you in notifying your staff, billing company or billing department about this upcoming change that will impact your payment for outpatient therapy services if unaware of this change. Thank you for being a Gold Member!

UnitedHealthcare (UHC) has updated their Multiple Therapy Procedure Therapy Reduction policy for physical, occupational and speech-language pathology therapy services provided in the private practice setting. To access the revised policy, click HERE. This policy applies to UHC Commercial Plans. I hope you enjoyed this free article.

Since January 1, 2019, facilities that provide post-acute care inpatient services have been required to request prior authorization and receive a pre-service determination before UnitedHealthcare (UHC) Medicare Advantage Plan members can be admitted to a post-acute care facility or a post-acute care bed in one of the following types of facilities: Acute Inpatient Rehabilitation Skilled Nursing Facilities Long-term Acute Care Hospitals Critical Access Hospitals that provide post-acute services Beginning on October 1, 2019, UHC will

UnitedHealthcare (UHC) has announced they have delayed the implementation of therapy specific modifiers (GN, GO, GP) to allow providers more time to adjust to changes in the submission of “Always Therapy” procedure codes to include the CMS required therapy modifiers. UHC has provided no new effective date at this time. This requirements was supposed to originally be effective with dates of service on and after July 1, 2019, but in June 2019, UHC further delayed the start of this new requirement until September 1, 2019. To read the latest on this issue straight from UHC, click I hope you enjoyed

UnitedHealthcare Community Plan has announced they will implement prior authorization for outpatient physical, occupational and speech therapy services in select states beginning as early with dates of service on and after August 1, 2019. In addition, UnitedHealthcare Community Plan has announced they will be conducting site of service medical necessity reviews for all speech, occupational and physical therapy services in select states. Effective with dates of service on and after August 1, 2019, the following states will be required to obtain prior authorization before implementing outpatient physical, occupational and/or speech therapy services:

UnitedHealthcare Community Plan has issued a revised coverage determination guideline for outpatient physical and occupational therapy. This policy applies to the following 12 states: