Posted in Training, Updates

UHC Oxford- updated Prior Auth changes 01/01/2023

Starting 01/01/2023 Oxford will add and remove certain codes that require prior authorizations (commercial line of business).

According the Oxford this change helps align their processes with evidence-based clinical guidelines.

Some of the new codes that will be added are:

For a full list of new codes that will be added to the list of codes that require prior authorization, please click here.

In addition Oxford is also adding a new provider tool, the UnitedHealthcare Oxford plan Prior Authorization Requirements document, it will become available as of Dec. 1, 2022, on the Advance Notification and Clinical Submission Requirements page.

Providers are encouraged to use this tool where they will be able to find/research codes that require prior authorization as well as request an auth.

Would you like to learn more: please click here, for the Applicable Oxford Commercial policies.

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Posted in Insurance, Updates

UHC-Computer Tomography code S8092 Update, for 2021

Effective 01/01/2021- CT code S8092, also known as ultrafast ct, cine ct, will not be subject to site of care/service medical necessity review.

This update/change will apply to UHC Commercial Plans including:

Oxford, Neighborhood Health Partnership and UnitedHealthcare of the River Valley

HCPCS code S8092 code is still subject to prior notification/authorization (medical necessity review).

UnitedHealthcare West or Sierra, at this time, are excluded from this policy update.

If you would like to read the whole the whole medical policy, Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan – Site of Service, click here.

Posted in Insurance, Training, Updates

Oxford Commercial Plan-E/M Code Reimbursement Policy Revised (non-physicians)-12/01/2020

Effective 12/01/2020-Oxford Commercial Plan has revised their E/M code reimbursement policy for Non Physician providers.

The policy expanded the Non-Physician Providers List that are not allowed to report E/M codes. Please see the partial list below:

Definitions: Physician- MD or DO

Guidelines as per Oxford: Only Physicians and other qualified healthcare professionals are allowed to bill E/M codes. These other qualified healthcare professionals include: “nurse practitioners (NP), clinical nurse specialists (CNS), certified nurse midwives (CNM) and physician assistants (PA), none of which are considered non physician health care professionals for purposes of this policy”.

Oxford will not reimburse E/M services (CPT codes 99091, 99201-99499) when reported by nonphysician health care professionals reporting under their own individual or group tax identification number (TIN).

According to the Oxford Policy- non physicians should use HCPCS ot/and CPT codes that correspond to the services that were performed (the most comprehensive CPT code that describes the services performed- as written by CMS).

To see the whole list of Non-physicians that this policy applies too, please click here.

#Oxford #EvaluationandManagment #E/M CPT codes #UHC