UnitedHealthcare has announced eight different outpatient procedures and service groups will require preauthorization in an outpatient hospital setting, but no prior authorization will be required if performed in an ambulatory surgery center.
Here are five things to know.
1. UnitedHealthcare made this policy change in an effort to reduce out-of-pocket costs for its members and minimize overall healthcare costs.
2. The new guidelines go into effect Oct. 1 for most states. The effective date is Nov. 1 for Colorado, and Dec. 1 for Illinois and Iowa.
3. The guidelines apply to the following:
• Abdominal paracentesis (Code 49083)
• Carpal tunnel surgery (Code 64721)
• Cataract surgery (Codes 66821, 66982 and 66984)
• Hernia repair (Codes 49585, 49587, 49650, 49651, 49652, 49653, 49654 and 49655)
• Liver biopsy (Code 47000)
• Tonsillectomy and adenectomy (Codes 42821 and 42826)
• Upper and lower GI endoscopy: (Codes 43235, 43239, 43249, 45380, 45384, 45385 and 45378)
• Urologic procedures (Codes 50590, 52224, 52281, 52352, 52000, 52234, 52310, 52353, 52005, 52235, 52332, 52356, 52204, 52260, 52351 and 57288)
4. The prior authorization requirement applies to the following plans:
• Golden Rule Insurance Company (group 902667)
• Mid-AtlanticMD Healthplan Individual Practice Association (MD IPA) or Optimum Choice products
• Neighborhood Health Partnership
• UnitedHealthcare of the River Valley Health Plan
• Health Exchanges
• UnitedHealthcare Oxford Health Plans
• UnitedHealthcare
• UnitedHealthcare Life Insurance Company (group 755870)
• UnitedHealthcare West
5. Prior authorization requests can be filed online or via telephone.