Insurer Delays Once in a Lifetime Procedures Policy

UnitedHealthcare announced in a May Network Bulletin Supplement that it is delaying implementation of the Once in a Lifetime policy. The insurer will reimburse claims for dates of service on or after Sept. 15—two weeks later than originally stated in its May Network Bulletin.

An appendix in the May Network Bulletin lists the CPT® codes for covered Once in a Lifetime procedures.

CPB : Online Medical Billing Course

Note: For dates of service on or after Sept. 15, UnitedHealthcare will only separately reimburse Once in a Lifetime procedures performed on subsequent dates of service after the original service was performed when reported with modifier 53 Discontinued procedure, modifier 55 Postoperative management only, modifier 56 Preoperative management only, modifier 58 Staged or related procedure or service by the same physician during the postoperative period.

Other policies the insurer is delaying include:

Moderate Sedation Policy – delayed from third quarter to fourth quarter 2010

Anesthesia Policy – Modifier 47 – delayed from third quarter to fourth quarter 2010

Coverage Update – UnitedHealthcare Services Company of the River Valley, Inc. – delayed from Aug. 1 to Sept. 1

See the May Network Bulletin Supplement for details.

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