Next Event: 2026 Documentation for Evaluations and Reevaluations for PT, OT, and SLP
Date: March 19,2026
UnitedHealthcare to Enforce Excludes 1 Diagnosis Guidelines
UnitedHealthcare has announced they will begin enforcing the application of Excludes 1 guidelines across all claim types to include outpatient and professional claim types. This will include outpatient therapy services.
To learn about Excludes 1 and diagnosis coding, read this article.
The effective date of UHC enforcing the application of Excludes 1 guidelines is
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Thanks for sharing this, Rick.
Would a simplified rule of thumb be to not include a generalized ICD-10 code with one that is more descriptive of that generalized code?
You need to look at the combination of ICD-10 codes you are placing on the claim and make sure that one is not Excludes1 of another on the claim.