UnitedHealthcare Washington Changes in Advance Notification and Prior Authorization Requirements

August 2019 ~

UnitedHealthcare (UHC) Washington has released a notice detailing which procedure codes will require prior authorization for UnitedHealthcare Community Plan of Washington.

Effective for dates of service on or after October 1, the following procedure codes will require prior authorization for UHC Community Plan of Washington:

Category: Continuous Glucose Monitor

Codes: A9276, A9277, A9278, K0553, K0554 (Continuous glucose monitors and supplies for members with Type 2 diabetes diagnosis only)

Category: Durable Medical Equipment (DME)

Codes: E0118, E0731

These changes, according to UHC, are part of the insurer’s ongoing efforts to evaluate medical policies, clinical programs and health benefits compared to the latest scientific evidence and medical specialty society guidance. Using evidence-based medicine to guide coverage decisions supports quality patient care and reflects our shared commitment to the Triple Aim of higher quality, improved health outcomes and better cost for members.

For more information and full details on the most recent changes to advance notification and prior authorization requirements, visit the UHC Prior Authorization and Notification page.

Source(s): UnitedHealthcare Network Bulletin August 2019;