Here are nine UnitedHealthcare reimbursement changes happening in the coming months:
- Molecular pathology policy, professional and facility: The new policy will no longer require submission of a unique test ID obtained through the Genetic Test Registry, but the policy will require the submission of a DEX-Z code.
- Anatomical modifier requirement policy, professional: United will align with CMS to provide correct coding requirements for percutaneous coronary intervention procedures.
- Age-based codes policy, professional: United will align with correct age-appropriate code submission, and procedure codes for members outside the appropriate age range for the codes will be ineligible for reimbursement.
- Anatomical modifier requirement policy, professional: United will align with CMS to provide correct coding requirements for percutaneous coronary intervention procedures.
- Device and skin substitute policy, facility: Appropriate device codes must be submitted on the same claim for the same date of service.
- Ordering and referring provider NPI CMS requirement: The ordering or referring provider must be identified on all claims initiated by orders or referrals.
- Observation and discharge policy, professional: Observation and discharge coding and guidelines will change based on CMS and American Medical Association guidance.
- Evaluation and management policy, professional: Reimbursement policies will align with CMS and the American Medical Association.
- Coronary anatomic modifier: Claims billed for percutaneous coronary interventions must include appropriate modifiers to identify which specific vessel is undergoing procedure.
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