NY UHC Community Plan- no payment for 97161-97168 codes

If you are a PT/OT provider in NY and accept UHC Community Health Plan patients? Then this blog post is for you!

What is changing?

UHC announced that for any DOS 12/1/26 and thereafter the codes 97161-97168 will be added to their non-covered code list.

Coding:

  • 97161-physicical therapy evaluation- low complexity
  • 97162- physical therapy evaluation – medium complexity
  • 97163- high complexity
  • Re-eval code-97164- with established plan of care
  • 97165- OT evaluation low complexity
  • 97166- OT evaluation – moderate complexity
  • 97167- OT evaluation  -high complexity
  • 97168- OT re-eval with established plan of care

UHC states that this change will align with NY Medicaid and sites Rehab Services and Procedure codes and Fee Schedule Provider Manual as reference.

What if you are a NY Independent Practitioner that provides services to Individuals with Developmental Disabilities?

  • As per NYS Medicaid these codes are covered and reimbursed
  • Please visit the following website for more info and rates

Reference Materials:

AOTA OT code info

Via AOTA

PT codes reference info: APTA please visit click here.

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