Tag: #UHC

Posted in Insurance, Updates

UHC-Computer Tomography code S8092 Update, for 2021

Posted on by KR2Medical Billing

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

Posted on by KR2Medical Billing

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

Posted in My services, Training, Updates

UHC Updated Telemedicine/Telehealth Policy for 2021

Posted on by KR2Medical Billing

Effective of 01/01/2021– UHC will change its Telehealth/Telemedicine Policy

This policy will apply to Oxford Plans as well

The following is the reimbursement policy for Telehealth/Telemedicine services:

-The only POS (place of service) that will be allowed is 02 (UHC: this is consistent with the Centers for Medicare and Medicaid (CMS) billing and reimbursement guidelines.)

-Modifiers 95, GT or G0 may be appended to telehealth claims reported with POS 2, BUT will not necessary be used to identify the telehealth services instead they are considered informational.

-UHC will consider the home of the member as an originating site for eligible services

 – Various codes will be eligible for consideration under the policy including the code list listed in the current policy, as well as similar types of services rendered using interactive audio and video technology.  (Please see the partial tables below)

-Certain physical, occupational and speech therapy (PT/OT/ST) telehealth services will be considered for reimbursement when performed by a qualified health care professionals and using interactive audio and video technology.

– The policy addresses additional ways of provider-patient communications including E-visits, remote patient monitoring (non-face-to-face, patient initiated communications, like online portals)

– Payment will align with applicable state law.  


Source: (UHC October provider bulletin)      
For full list of covered codes please click here