UnitedHealthcare Changes in Advance Notification and Prior Authorization Requirements

October 2018 ~

UnitedHealthcare has issued the following procedure codes that will soon require prior authorization for certain services provided on or after December 1.

Code Additions to Prior Authorization

Due to state mandate for UnitedHealthcare  Community  Plan  of  Florida  (MMA, LTC Plans), effective for dates  of  service  on  or  after December  1, 2018, UHC will require prior authorization for the following procedure codes:

Acupuncture

Codes: 97810, 97811, 97813, 97814

Chiropractic Services

Codes: 98940, 98941, 98942, 98943 

Massage Therapy for Pain Management

Codes: 97010, 97112, 97140, 97124

Effective for dates of service on or after January 1, 2019, the following procedure codes will modify prior authorization requirements for UnitedHealthcare Medicare Advantage Plans (UnitedHealthcare West, UnitedHealthcare Community Dual Special Needs Plans, UnitedHealthcare Community Plan Massachusetts Senior Care Options, UnitedHealthcare Community Plans-Medicare; excludes Medica and Preferred Care of Florida health plan):

Durable Medical Equipment (DME) – Regardless of Billed Amount (changed from “when billed with accumulative rental or purchase price of >$1K”)

Codes: E0466

Effective for dates of service on or after January 1, 2019, the following procedure codes will require prior authorization for UnitedHealthcare Community Plan of Texas (StarPlus Plan):

Orthotics/Prosthetics

Codes: L1810, L1831, L1843, L1932, L1951, L1960, L2280, L2999, L3000, L3010, L3020, L3216, L3221, L3960, L4631, L5000, L5611, L5620, L5624, L5629, L5631, L5637, L5645, L5647, L5649, L5650, L5671, L5673, L5679, L5685, L5700, L5701, L5704, L5705, L5707, L5845, L5910, L5920, L5940, L5962, L5972, L5986, L8000, L8001, L8002, L8010, L8015, L8020, L8030, L8031, L8032, L8035, L8039, L8420, L8499, L8500

Effective for dates of service on or after January 1, 2019, the following procedure codes will now require prior authorization when billed with the defined diagnosis codes for UnitedHealthcare Community Plan of Maryland (Medicaid Plan):

Gender Dysphoria Treatment

Codes: 14021, 14061, 14301, 14302

Diagnosis Codes: F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890

Effective for dates of service on or after January 1, 2019, the following procedure codes will require prior authorization for UnitedHealthcare Community Plan of Louisiana (Medicaid Plan):

Durable Medical Equipment (DME)

Codes: E1220

Effective for dates of service on or after January 1, 2019, the following procedure codes will require prior authorization for UnitedHealthcare Community Plan of California (Medicaid Plan):

Dental Anesthesia

Codes: 00170

Effective for dates of service on or after January 1, 2019, the following procedure codes will require prior authorization for UnitedHealthcare Community Plan of New York (Medicaid, HARP, CHIP, EPP, LTSS Plan):

Experimental/ Investigational

Codes: A9274

Effective for dates of service on or after January 1, 2019, the following procedure codes will require prior authorization for UnitedHealthcare Commercial Plans (UnitedHealthcare Mid Atlantic Health Plan, Navigate, Neighborhood Health Partnership, UnitedHealthOne, UnitedHealthcare Commercial, UnitedHealthcare of the River Valley and UnitedHealthcare West):

DME

Codes: E0466

Effective for dates of service on or after January 1, 2019, the following procedure codes will require prior authorization to obtain the face-to-face documentation for UnitedHealthcare Community Plan of Kansas (Medicaid, CHIP, LTSS Plan):

Incontinence Supplies

Codes: T4521-T4535, T4543

Source(s): UnitedHealthcare Network Bulletin October 2018;