UHC Medical Policy and Reimbursement Updates

November 2017 ~

UnitedHealthcare has released several policy and reimbursement updates that will take effect on December 1, 2017. These updates are as follows:

  • Blepharoplasty, Blepharoptosis and Brow Ptosis Repair
    • This policy addresses upper eyelid blepharoplasty, upper eyelid blepharoptosis repair, brow ptosis, eyelid surgery with an anophthalmic socket, lower eyelid blepharoplasty, ectropion or punctal eversion, entropion, lid retraction surgery, canthoplasty/canthopexy, and repair of floppy eyelid syndrome (FES).
      • Applicable Procedure Codes: 15820, 15821, 15822, 15823, 21280, 21282, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67950, 67961, 67966.
  • Attended Polysomnography for Evaluation of Sleep Disorders
    • This policy addresses home sleep apnea testing (HSAT) using a portable monitor, attended full-channel nocturnal polysomnography, actigraphy, multiple sleep latency testing (MSLT), maintenance of wakefulness testing (MWT), abbreviated daytime sleep study, split-night sleep study, and attended repeat testing.
      • Applicable Procedure Codes: 0381T, 0382T, 0383T, 0384T, 0385T, 0386T, 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400.
  • Bariatric Surgery Policy
    • This policy addresses bariatric surgical procedures, including robotic-assisted gastric bypass surgery, surgical adjustment or alteration of a prior bariatric procedure, and gastrointestinal liners.
      • Applicable Procedure Codes: 0312T, 0313T, 0314T, 0315T, 0316T, 0317T, 43210, 43644, 43645, 43647, 43648, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43842, 43843, 43845, 43846, 43847, 43848, 43860, 43865, 43881, 43882, 43886, 43887, 43888, 43999, 64590, 64595, 95980, 95981, 95982.
  • Blepharoplasty, Blepharoptosis and Brow Ptosis Repair
    • This policy addresses upper eyelid blepharoplasty, upper eyelid blepharoptosis repair, brow ptosis, eyelid surgery with an anophthalmic socket, lower eyelid blepharoplasty, ectropion or punctal eversion, entropion, lid retraction surgery, canthoplasty/canthopexy, and repair of floppy eyelid syndrome (FES).
      • Applicable Procedure Codes: 15820, 15821, 15822, 15823, 21280, 21282, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67950, 67961, 67966.
  • Minimally Invasive Procedures for Gastroesophageal Reflux Disease (GERD)
    • This policy addresses endoscopic therapies and the LINX™ Reflux Management System for treating gastroesophageal reflux disease (GERD).
      • Applicable Procedure Codes: 43284, 43257, 43289, 43499, 43999.
  • Neurophysiologic Testing and Monitoring Policy
    • This policy addresses electromyography (EMG), nerve conduction studies, physiologic recording of tremor, quantitative sensory testing, and visual evoked potentials for glaucoma.
      • Applicable Procedure Codes: 0106T, 0107T, 0108T, 0109T, 0110T, 0464T, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870, 95872, 95873, 95874, 95885, 95886, 95887, 95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95937, 95999, 96002, 96003, 96004, G0255, S3900.
  • Preterm Labor Management Policy
    • This policy addresses tocolytic therapy, subcutaneous terbutaline pump maintenance therapy, magnesium sulfate, and home uterine activity monitoring (HUAM).
      • Applicable Procedure Codes: J3105, J3475, S9001, S9208, S9349.

 

Source(s): UnitedHealthcare Network Bulletin;

 

 

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