The policy includes 1,041 codes for commercially insured patients and 167 codes for Medicare Advantage patients that require pre-authorization for the surgery to be performed in a hospital outpatient department.
Unless it is determined that receiving the procedure in an HOPD is medically necessary, “UnitedHealthcare members may choose to receive surgical procedures in an ASC,” the policy reads.
The move will direct surgeries to be performed at ASCs, Naya Kehayes, partner and ASC practice leader at ECG Management Consultants, said at a March 22 California Ambulatory Surgery Association summit with payers and industry stakeholders.
UnitedHealthcare is facing opposition from more than 175 groups for its separate decision to require prior authorization for gastroenterology endoscopy services, including esophagogastroduodenoscopies, capsule endoscopies, diagnostic colonoscopies and surveillance colonoscopies.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.