UnitedHealthcare Prior Authorization and Coding Policy Updates

December 2017 ~

UnitedHealthcare (UHC) has announced two updates for notification and prior authorization on certain procedures, as well as revisions to its emergency department facility evaluation and management (e/m) coding policies.

Update to Notification/Prior Authorization Requirements

Effective January 1st, 2018 Notification/ prior authorization will no longer be required for an abdominal paracentesis procedure for UHC Commercial plans, except for some of UHC affiliate plans.

Changes in Advance Notification and Prior Authorization Requirements

As of October 1st, continuous airway pressure (CPAP) device code E0601 no longer requires prior authorization.

Revised and New Emergency Department (ED) Facility Evaluation and Management (E/M) Coding Policies

Effective March 1st, UHC will revise the current Emergency Department (ED) Facility Evaluation and Management (E/M) Coding Reimbursement Policy for UHC Commercial Plans and adopt new policies for UHC Medicare Advantage plans, as well as UHC Community Plans in select states.


Source(s): UnitedHealthcare Network Bulletin;