UnitedHealthcare has announced significant changes to how GI procedures will be reimbursed, according to the American Gastroenterological Association.
Here are three things to know.
1. Starting Nov. 15, UnitedHealthcare will use CMS special multiple endoscopic resection rules on specific commercial claims.
2. The payer will allow the full allowable amount for the highest valued endoscopy code in the family when multiple procedures from the same family are reported on the same day, according to the report.
3. UnitedHealthcare's multiple surgery reduction rule will continue to apply to endoscopy codes in different families. In this case, the primary procedure will be reimbursed at 100 percent. A 50 percent reduction is applied to the second procedure, and a 25 percent reduction is applied to all subsequent procedures, according to the report.
Click here to read the full UnitedHealthcare bulletin.