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 physical therapy, occupational therapy and speech-language pathology services for both habilitative and rehabilitative therapy services and you might be surprised which CPT codes are not listed for occupational therapy.
If you treat any UHC commercial patients, especially pediatrics for habilitative therapy, this is a must read policy to read and understand or you risk not being paid for therapy services. To access this updated coverage determination guideline, click
I hope you found this article helpful and that it will assist you with the provision and billing of outpatient habilitative and rehabilitative therapy services to your UHC commercial plan patients. Thank you for being a Gold Member!