UnitedHealthcare Makes Fourth-Quarter Policy Changes

UnitedHealthcare is making several important reimbursement and medical policy changes that may affect your physicians’ office.

Medical Policy Changes

UnitedHealthcare is adopting the policy that chemoresistance assays (including Oncotech Extreme Drug Resistance assay or EDR®) and chemosensitivity assays (including ChemoFX® assay) are unproven for prediction of response to chemotherapy.

“Results of the available studies fail to provide convincing evidence that information obtained with chemoresistance and chemosensitivity testing is useful to treat cancer patients,” UnitedHealthcare writes in its July 2009 Network Bulletin.

Standards have yet to be established for the use of in vitro chemosensitivity and chemoresistent assays, the carrier says.

“Well-designed prospective, randomized controlled clinical trials are needed to determine the potential clinical rule of assay-directed therapy and its impact on tumor response and patient survival,” according to UnitedHealthcare.

Reimbursement Policy Changes

UnitedHealthcare also announced in July that it is revising its Add-On Reimbursement policy to separately reimburse for add-on CPT® code 99292 Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes when reported by a different physician of the same group and specialty reporting the primary procedure 99291 Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes.

Likewise, the carrier is changing Contrast and Radiopharmaceutical Materials policy provisions to apply to all physicians and/or other health care professionals of the same group reporting the same federal tax identification (rather than the same individual physician or other health care professional).

These and several other policy revisions and updates apply to services reported using the 1500 Health Insurance Claim Form (CMS-1500) or its electronic equivalent or its successor form; and are targeted for implementation in the fourth quarter of 2009.

In other news …

Effective Sept. 1, initial claim acknowledgement letters are available exclusively online at UnitedHealthcare Online and have been discontinued for mail delivery. UnitedHealthcare will continue to deliver other claim acknowledgement letters via mail and online.

For more information on these announcements, and for other important news regarding recent policy changes, read the July 2009 Network Bulletin on UnitedHealthcare Online.

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