Here are five things to know.
1. UnitedHealthcare made this policy change in an effort to reduce out-of-pocket costs for its members and minimize overall healthcare costs.
2. The new guidelines go into effect Oct. 1 for most states. The effective date is Nov. 1 for Colorado, and Dec. 1 for Illinois and Iowa.
3. The guidelines apply to the following:
• Abdominal paracentesis (Code 49083)
• Carpal tunnel surgery (Code 64721)
• Cataract surgery (Codes 66821, 66982 and 66984)
• Hernia repair (Codes 49585, 49587, 49650, 49651, 49652, 49653, 49654 and 49655)
• Liver biopsy (Code 47000)
• Tonsillectomy and adenectomy (Codes 42821 and 42826)
• Upper and lower GI endoscopy: (Codes 43235, 43239, 43249, 45380, 45384, 45385 and 45378)
• Urologic procedures (Codes 50590, 52224, 52281, 52352, 52000, 52234, 52310, 52353, 52005, 52235, 52332, 52356, 52204, 52260, 52351 and 57288)
4. The prior authorization requirement applies to the following plans:
• Golden Rule Insurance Company (group 902667)
• Mid-AtlanticMD Healthplan Individual Practice Association (MD IPA) or Optimum Choice products
• Neighborhood Health Partnership
• UnitedHealthcare of the River Valley Health Plan
• Health Exchanges
• UnitedHealthcare Oxford Health Plans
• UnitedHealthcare
• UnitedHealthcare Life Insurance Company (group 755870)
• UnitedHealthcare West
5. Prior authorization requests can be filed online or via telephone.
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