New Jersey – Site of Service Prior Auth. Requirements for Certain Procedures to Expand

January 2018 ~

For dates of service on or after April 1st, UnitedHealthcare is expanding notification/prior authorization requirements for certain services to be covered in certain sites of care to include commercial members in Indiana and New Jersey.

The following requirements, already in place in other states, will apply to UnitedHealthcare commercial members in Indiana and New Jersey beginning as of April 1st:

Outpatient Hospital Setting

  • Carpal Tunnel – 64721
  • Cataract 66821 – 66982 66984
  • Cosmetic and Reconstructive – 13101 13132 14040 14060 14301 21552 21931
  • Ear, Nose and Throat – 21320 30140 30520 69436 69631
  • Gynecology – 57522 58353 58558 58563 58565
  • Hernia Repair – 49505 49585 49587 49650 49651 49652 49653 49654 49655
  • Liver Biopsy – 47000
  • Ophthalmology – 65426 65730 65855 66170 66761 67028 67036 67040 67228 67311 67312
  • Tonsillectomy & Adenoidectomy – 42820 42821 42825 42826 42830
  • Upper & Lower Gastrointestinal Endoscopy – 43235 43239 43249 45378 45380 45384 45385
  • Urology – 50590 52000 52005 52204 52224 52234 52235 52260 52281 52310 52332 52351 52352 52353 52356 54161 55040 55700 57288
  • Miscellaneous – 20680

Any Setting Other Than a Physician’s Office

  • Dermatologic -10120 10140 11400 11401 11402 11403 11404 11406 11420 11421 11422 11423 11424 11426 11442
  • Gastroenterology – 45300 45330 46922
  • General Surgery – 19000
  • Neurologic – 62270 62320 62321 62322 62323 64633 64635
  • Muscular/Skeletal – 27096 64479 64483 64490 64493 64520
  • Obstetrics/Gynecology – 57460
  • Respiratory – 31579
  • Urology – 55250
  • Vascular – 36473 36475 36478

 

Source(s): UnitedHealthcare Network Bulletin;

 

 

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