Posted in #unitedhealthcare, Training, Updates

UHC Community Health (NY): nerve block reimbursement policy

Most commonly I receive the questions regarding separate reimbursement of nerve blocks like TAP (Transversus abdominis plane (TAP) block for abdominal surgery)- codes 64486 – 64489 Transversus abdominis plane (TAP) block. Unfortunately every insurance payer has its own policy regarding nerve block reimbursement. So, making sure that your medical biller knows where to look for that information is imperative to reduce unnecessary denials and improve your A/Rs.

If you are a surgeon that accepts UHC Community health patients then this blog post is for you!

According to UHC Community Health Provider communications: the below policy will be effective for DOS on or after 07/01/2021.

This change is made to align with NY State regulations.

The following is said:

“Administration of a nerve block (either as a component of the anesthesia itself or a postoperative pain management protocol) is considered part of the anesthesia time for the surgery. This will not be reimbursed as a separate and distinct procedurals services when performed by the same provider (or his/her associate) that has provided the same anesthesia for the surgical procedure itself.

Also Post Op visits are included in the total value for anesthesia services.

Healthy Medical Coding and Billing Practices: FREE MEDICAL BILLING AND CODING ADVICE!

It is important to make sure you are billing the proper codes. Billing code 69990 is not acceptable for TAP done for Laparoscopic procedure. Billing this code will trigger unnecessary denials and if you are an OON provider will not be as a “covered procedure” and the “provider total charge” will be applied to patient responsibility.

More Posts:

Need medical coding and billing training for your staff? Please visit my Services Page to register for my on demand or live training/consulting sessions. (via zoom/google meets)

Need a speaker? Please visit my Services Page to fill out the request form.

#nerveblock #cpt69990, #cpt64486, #denials, #uhccommunityhealth, #reimbursement



My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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