In August, UnitedHealthcare announced plans to reduce 20% of its prior authorization requirements for its members and member physicians beginning on Sept. 1.
On Sept. 1, the payer began the first stage of its two-phased approach, eliminating codes for UnitedHealthcare Medicare Advantage, UnitedHealthcare commercial, UnitedHealthcare Oxford and UnitedHealthcare Individual Exchange plan members.
While UHC said it was making the change in an "effort to simplify the healthcare experience for our members and network health care professionals," many physicians are skeptical of the changes.
Two surgeons told Becker's that UHC is simply cutting codes that the majority of physicians never use in a move that is solely for optics.
"The codes that were eliminated are some of the least utilized codes. I'm not sure I have billed any of those codes in the last 10 years, or perhaps have only done so a handful of times," Adam Bruggeman, MD, an orthopedic surgeon at San Antonio-based Texas Spine Care Center, told Becker's.
The second wave of cuts for members holding UnitedHealthcare Community Plans began on Nov. 1.
Codes are being removed for specialities and procedures including cardiology, genetic testing, hysterectomy, spine surgery, radiology, arthroplasty, vein procedures and site of service sterilization.
With cardiology, spine and arthroplasty procedures moving toward the ASC setting, ASCs providing these specialities may see a reduction in a handful of prior authorization requirements.
Cut spine surgery codes include 22864 (removal disc arthroplasty anterior 1 interspace cervical), 22865 (removal disc arthroplasty anterior 1 interspace lumbar) and 0095T (removal total disc arthroscopy anterior approach, each additional interspace, cervical), while cut cardiology codes include 93303 (complete transthoracic echocardiography for congenital cardiac anomalies), 93304 (transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study) and 93306 (performing and interpreting of a complete transthoracic echocardiogram).