If UnitedHealthcare is among your list of payers, you’ll want to take note of several policy updates the insurer says it will implement on or before the fourth quarter of 2012. From prior authorization changes to supply codes no longer separately payable, the July 2012 Network Bulletin is a must-read. Here are the highlights:
Notification and Prior Authorization Program Changes
Effective Nov. 1, certain UnitedHealthcare commercial customers will be required to obtain prior authorization and/or advance notification for attended sleep testing performed in a health care facility. Unattended home sleep testing will not require prior authorization, nor will providers be required to submit a patient information worksheet (PIW). Radiology
Effective Aug. 13, the UnitedHealthcare Commercial Radiology Notification Program and Medicare Advantage Radiology Prior Authorization Program are expanding to include Connecticut, New Jersey, and New York. Cardiology
Effective Oct. 1, UnitedHealthcare will require providers to obtain prior authorization for echocardiograms, stress echos, diagnostic catheterizations, and electrophysiology implants when furnished in an outpatient facility or physician office. Prior authorization will be required for electrophysiology implants regardless of where the service is performed. Note, however, that prior authorization is not required for these services when rendered in an emergency room (ER), observation unit, or urgent care facility.
A complete list of plans that are subject to this prior authorization requirement is available at UnitedHealthcareOnline.com.
Clinical and Surgical Pathology
Effective fourth quarter 2012, UnitedHealthcare’s Laboratory Rebundling policy will be revised to include dermatologists as eligible for reimbursement when reporting clinical and surgical pathology consultation codes (CPT® 80500-80502 and 88321-88325).
In accordance with National Correct Coding Initiative (NCCI) edits, UnitedHealthcare’s CCI editing policy will be revised in the fourth quarter to deny CPT® codes 29874 Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation) and 29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) when they are reported with other reimbursable knee arthroscopy procedures (29866-29889). After this edit is in place, a modifier override will not be allowed as it has been in the past.
UnitedHealthcare says it will expand its current list of supply codes that are not separately payable when reported with an evaluation and management (E/M) service and/or procedure provided on the same day in a physician or other health care professional’s office. The complete list of codes that will be added to the Supply Policy Non Reimbursable Code List can be found on pages 55-59 in July’s Network Bulletin.