Science is wondeful and brings us many new innovations that help people improve health!
Now if you are a provider that accepts UHC Community Plan members, then this blog post is for you!
Which plans are affected?
- Arizona
- Colorado
- Florida
- Hawaii
- Kansas
- Kentucky
- Maryland
- New Mexico
- New York
- Ohio
- Pennsylvania
- Rhode Island
- Tennessee
Which codes are affected?
- 0569T-Transcatheter tricuspid valve repair, percutaneous approach; initial prosthesis: This code is used for the placement of the first device to repair the tricuspid valve.
- 0570T-Transcatheter tricuspid valve repair, percutaneous approach; each additional prosthesis during same session: This is an add-on code used for any subsequent devices placed during the same procedure.
What changed?
- Due to recently new scientific evidene these services are now considered proven in certain clinical circumstances and will require a medical necessity review to determine whether criteria are met
- Click here to get the clinical criteria
Effective DOS?- July 1st 2026 and thereafter
Need to request an auth?
- Visit UHC portal
Find this information useful? Follow my blog for more!
- UHC Community Health: new prior auth for heart valve procedures
- NC Medicaid: proper use of CR modifier
- UHC TX Medicaid: labolatory requirement
- PA Medicaid: Community Health Workers- update
- Highmark NY: prior authorization update- meds through medical benefit
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