UnitedHealthcare Requires Radiology Notification
- By admin aapc
- In Coding
- December 14, 2009
- Comments Off on UnitedHealthcare Requires Radiology Notification
UnitedHealthcare recently announced an important policy change whereas all network physicians will be required to participate in the health plan’s Radiology Notification Program, effective Feb. 15, 2010.
The Commercial Radiology Notification Program requires prior notification from participating physicians and other health care professionals, as well as facilities and ancillary providers, before ordering CT scans, MRIs, MRAs, PET scans, and nuclear medicine studies, including nuclear cardiology.
The ordering physician’s office requesting the imaging service is responsible for obtaining a notification number prior to scheduling advanced outpatient imaging procedures.
Key components that UnitedHealthcare says led to this policy change include concern for unwarranted radiation exposure by the insured, administrative complexities and inconsistencies, and imaging inefficiencies.
UnitedHealthcare states in a FAQ found on its Web site:
“The decision to include all network physicians, including Premium Quality and Cost Efficiency designated physicians in the notification program is based on UnitedHealthcare’s concern for patients who are subject to preventable radiation exposure, as well as direct feedback from participating physicians and office managers, who, while appreciating the exemption for UnitedHealth Premium designated physicians, have also reported additional administrative complexity in managing these exemptions.”
The 2009 Radiology Notification Table, which is a chart containing the CPT® and HCPCS Level II codes requiring notification, is available at UnitedHealthcareOnline.com.
Under the CPT® Code Crosswalk Table, for certain CPT® code combinations, physicians and other health care professionals are not required to contact the Radiology Notification Program to modify the existing notification record. A complete listing of 2009 crosswalk codes is available at UnitedHealthcareOnline.com.
For further information regarding the Radiology Notification Program, refer to UnitedHealthcare’s “Outpatient Radiology Notification Protocol” white paper.
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Due to the number of denials received when the ordering physican is a Q&E provider, the change is probably caused by UHC’s inability to correctly administer this program.