Tag: #radiology

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

Find this content useful? Follow my Blog!

Posted in #aetna, #Medicare, #Medicareadvantage

Aetna Reimbursement Policy: Radiology Modifiers

Posted on by KR2Medical Billing

According to provider October updates: Aetna will reduce the reimbursement rate for HCPCS radiology codes when modifiers FX and FY are appended.

Modifier FX: the reimbursement rate will be reduced by 20% for the technical component and the (technical component of a global fee) Definition: x-ray images taken by using film

Modifier FY: the reimbursement rate will be reduced by 10% for the technical component and the (technical component of the global fee) Definition: computed radiography X-ray)

Effective for any DOS on or after 1/1/2024.

Type of plans affected: commercial and Medicare lines of business plan types.

Pages: 1 2
Posted in MVP (NY/VT) Insurance Payer, NY Providers, Payer Updates, Payers and CPT reinbursement, Training

MVP Insurance Payer update: change to Trabecular Bone Scans Reimbursement.

Posted on by KR2Medical Billing

Effective September 1st 2023, MVP will NO longer reimburse separately for Trabecular Bone Scans when done during the Bone density studies.

These scans will he considered incidental to the bone density studies.

CPT codes for Trabecular Bone Studies: 77089,77090,77091, and 77092.

DXA or bone density scan CPT codes that apply to this policy (using central and peripheral dual-enery X-ray are: 77080,77081, and 77085.

This updated reimbursement policy applies to all MVP LOBs- commercial, Managed medicaid and Medicare Advantage Plans.

Find this type of updates useful? Follow my blog for more medical billing and coding guidelines and reimbursement updates.