This policy is retroactive as of 12/01/2020.
This policy change affects the following plans:
- UnitedHealthcare Community Plan for Families (Medicaid)
- UnitedHealthcare Community Plan Wellness 4 Me (HARP)
The non-covered codes section clarifies and supplements the UnitedHealthcare Community Plan of New York National Outpatient Physical and Occupational Therapy policy. All other CPT codes for physical and occupational therapy services will be considered non-covered.
Please still check the member benefit plan document that may supersede the additional considerations and coverage limitations and exclusions and prior authorization requirements.
Partial PT/OT covered list:
Partial Non-covered codes list: