Category: NY Providers

Find Medical Billing and Coding guidance for any Providers that operate in NY State

Posted in #Medicareadvantage, #unitedhealthcare, NY Providers, Prior Authorization Insurance Carrier Updates

UHC to remove prior auth for some radiology and cardiology tests.

Posted on by KR2Medical Billing

Starting Jan 1, 2026 certain nuclear imaging tests, OBGYN ultrasounds, and certain cardiology tests will no longer require a prior authorization for some of the  following plan types:

1.UnitedHealthcare Insurance Company
2.UnitedHealthcare Mid-Atlantic, inc. 
3.UnitedHealthcare Plan of the River Valley, Inc. and 4.UnitedHealthcare Insurance Company of the River Valley
5.Oxford Health Insurance, Inc.
United Healthcare Level Funded (formerly All Savers Life Insurance Company of California)
6.Neighborhood Health Partnership, Inc.
7.UnitedHealthcare Individual Exchange plans, also referred to as UnitedHealthcare Individual and Family ACA Marketplace plans
8.UnitedHealthcare Services, Inc.
9.UnitedHealthcare Community Plans

Some of the affected codes are:

Image via UHC website

For a full list of affected codes please click here: https://www.uhcprovider.com/en/resource-library/news/2025/removal-prior-auth-radiology-cardiology.html

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Posted in #reimbursement, BCBS Empire NY, NY Providers, Payer Updates, Prior Authorization Insurance Carrier Updates

Anthem BCBS NY: New PET tracer UM policy

Posted on by KR2Medical Billing

The following information will apply to any DOS on 12/1/25 and thereafter.

Starting 12/1/25 the PET tracer will require an auth in addition to PET services.

Please submit both PET and radiotracer codes- for prior authorization. The UM criteria for PET will not be affected. However both codes will be either approved or denied. Please note that the radiotracer must coorespond to the requested PET code.

The following codes will be affected:

Image via Anthem BCBS
Image via Anthem BCBS
Image via Anthem BCBS

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Posted in #aetna, #reimbursement, NY Providers, Payer Updates, Training

PrEP proper billing and coding

Posted on by KR2Medical Billing

Proper Medical coding and billing is important to the financial health of your practice!

Medication codes:

Image via Google

Administration code

Please avoid using the regular 96372 administration code. Instead use the following administration code: G0012

This code is used when the provider physically administers the PrEP medication.

Supply Code

For the oral PrEP pharmacies should bill: Q0251

Image via Google

ICD-10 codes:

F19.10, F19.20, Z11.3, Z11.4, Z20.2, Z20.6, Z29.81, Z72.51- Z72.53, Z72.89, Z79.899

These services are classified as preventative medicine.

Based on which insurance payers your office accepts, there can be some variations of coverage to the additional services that may be related to PrEP. Please make sure you check with the insurance payers before performing any services for additional coverage information.

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