Are you a provider that accepts members with the following plans: UHC commercial, Medicare Advantage, and some UHC plans? Then this blog post is for you!
What is changing?
- For any dos 12/1/26 and thereafter UHC will require a prior authorization/ medical necessity review for code 37242
- UHC will remove the site of services requirenment for therapeutic vascular procedures (ex. 37243)
- UHC plans that previously did not require an auth for code 37242 – will not be implemented for medical necessity review
Coding:
- 37242- Vascular embolization or occlusion of an artery for conditions other than active bleeding, tumors, or ischemia.
- 37243- Vascular embolization or occlusion of an artery specifically performed to treat tumors, organ ischemia, or targeted tissue infarction.
Please click here to review the policies.
Excluded plans: this change doesnt apply to all of the UHC plans.
- Rocky Mountain Medicare Advantage Plans
- People’s Health Plan
- Erickson Advantage
- Preferred Care Network and Preferred Care Partners of Florida
- UnitedHealthcare Nursing Home and UnitedHealthcare Assisted Living Plans
UHC Community health plans that are currently excluded, but do fall under the state specific medical necessity review and are currently waiting for an approval:
- UHC NJ
- UHC Idaho
- UHC Nebraska
- UHC Ohio
- UHC New Mexico
- UHC Kansas
- UHC Kentucky
Find this information useful? Follow for more!
- UHC: new vascular embolization criteria/policy
- UHC: GI endoscopy advance notification and SOS update
- Healthfirst Prior auth updates 11/1/26
- NYS Medicaid: proper billing and coding for HBOT
- NYS Medicaid Telehealth updates
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