Uhc billing services
[PDF File] We are here to help you - UnitedHealthcare
http://5y1.org/file/11211/we-are-here-to-help-you-unitedhealthcare.pdf
We’re serious about your success: Your dedicated, professional team is here to support you when you need us. Small Business (2-100) Broker Service Support Phone (toll-free): 1-800-591-9911. Email: clientserviceoperations@uhc.com.
[PDF File] Injection and Infusion Services Policy, Professional
http://5y1.org/file/11211/injection-and-infusion-services-policy-professional.pdf
Non-Facility Injection Services: E/M services provided in a non-facility setting are considered an inherent component for providing an Injection service. CPT indicates these services typically require direct supervision for any or all purposes of patient assessment, provision of consent, safety oversight, and intra-service supervision of staff.
[PDF File] Nonphysician Health Care Professionals Billing Evaluation and ...
http://5y1.org/file/11211/nonphysician-health-care-professionals-billing-evaluation-and.pdf
Nonphysician Health Care Professionals Billing Evaluation and Management Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial and Individual Exchange Subject: This policy describes reimbursement for Evaluation and Management (E/M) services (99201 99499) reported by nonphysician health care professionals. …
[PDF File] UnitedHealthcare Telehealth Visit Guide
http://5y1.org/file/11211/unitedhealthcare-telehealth-visit-guide.pdf
The telehealth visits guide is meant to help your practice build your telehealth capabilities and support your telehealth journey. This guide outlines the basic steps to prepare a practice to deliver telehealth, ofers tips and best practices and suggests tools to measure telehealth’s efectiveness for the practice. 340%.
[PDF File] Services Incident-to a Supervising Health Care Provider and …
http://5y1.org/file/11211/services-incident-to-a-supervising-health-care-provider-and.pdf
take part of the history, the billing practitioner must perform the level of history required to select the visit level billed. If physical exam is used as the substantive portion and both practitioners examine the patient, the billing practitioner must perform the level of exam required to select the visit level billed.
[PDF File] Organ and Tissue Transplants
http://5y1.org/file/11211/organ-and-tissue-transplants.pdf
stem cells are obtained from the recipient himself or herself), because autologous transplants involve services provided to the beneficiary only (and not to a donor), for which the hospital may bill and receive payment. Refer to the Medicare Claims Processing Manual, Chapter 4, §231.11 - Billing for Allogeneic Stem Cell Transplants.
[PDF File] 2024 Medicare Advantage preventive screening guidelines
http://5y1.org/file/11211/2024-medicare-advantage-preventive-screening-guidelines.pdf
The following coding procedures for UnitedHealthcare® Medicare Advantage plans in 2024 can help you determine the appropriate submission codes for covered preventive services. For more information about the Centers for Medicare & Medicaid Services (CMS) policies that define the procedures, and to determine if a service is covered by Medicare ...
[PDF File] COBRA participant guide - Billing Services
http://5y1.org/file/11211/cobra-participant-guide-billing-services.pdf
Administrative services provided by UnitedHealthcare Insurance Company, United HealthCare Services, Inc. or their affiliates. Health Plan coverage provided by or through a UnitedHealthcare company. ... UHC Graphics Department 952-992-4797 Created Date:
[PDF File] Preventive Care Services
http://5y1.org/file/11211/preventive-care-services.pdf
Pelvic Examination add-on code 99459: Preventive care services benefits may apply to 99459 when the related code is applied to the preventive care services benefit. CPT code 99459 may not be payable in all circumstances due to other policies or guidelines. Breastfeeding Services and Supplies. 98960, 98961, 98962, 992.
[PDF File] Anesthesia Policy, Professional
http://5y1.org/file/11211/anesthesia-policy-professional.pdf
The Same Individual Physician or Other QHP is defined as the same individual rendering health care services reporting the same Federal Tax Identification number. Procedural or Pain Management Services Bundled in Anesthesia Services: • Services in the CMS National Physician Fee Schedule that have a status indicator of B (Bundled code) or T
[PDF File] Laboratory Services Policy, Professional
http://5y1.org/file/11211/laboratory-services-policy-professional.pdf
All entities billing for laboratory services should append identifying modifiers (e.g., 90), when appropriate, in accordance ... services are performed for the same patient on the same day. UnitedHealthcare will reimburse laboratory services reported with modifier 59, XE, XP, XS, or XU for different species or strains, as well as Specimens from ...
[PDF File] ABA Care Provider Orientation
http://5y1.org/file/11211/aba-care-provider-orientation.pdf
Members are eligible to receive applied behavioral analysis (ABA) services when they: Are all ages except the day treatment program which is restricted to ages 2–5. Are covered under Washington Apple Health. Have a comprehensive evaluation and written order for ABA therapy from a recognized center of excellence (COE) And meet at least 1 of ...
[PDF File] Acupuncture Policy, Professional
http://5y1.org/file/11211/acupuncture-policy-professional.pdf
patient, addresses supplies that are included in the Acupuncture services and describes the submission of evaluation and management services in conjunction with Acupuncture services. All services described in this policy may be subject to additional UnitedHealthcare reimbursement policies including, but
[PDF File] Hospital, Emergency, and Ambulance Services
http://5y1.org/file/11211/hospital-emergency-and-ambulance-services.pdf
Hospital services (inpatient, outpatient, and observation services), emergency services, and ambulance services are covered when Medicare criteria are met. Medicare does not cover emergency and urgent services provided outside of the United States. Some UnitedHealthcare Medicare Advantage (MA) plans may provide coverage for out-of-area …
[PDF File] Preventive Medicine and Screening Policy, Professional
http://5y1.org/file/11211/preventive-medicine-and-screening-policy-professional.pdf
Preventive Medicine Services [Current Procedural Terminology (CPT®) codes 99381-99387, 99391-99397, Healthcare Common Procedure Coding System (HCPCS) code G0402] are comprehensive in nature, reflect an age and gender appropriate history and examination, and include counseling, anticipatory guidance, and risk factor reduction
[PDF File] Outpatient Rehabilitation Therapy Services Policy, Facility
http://5y1.org/file/11211/outpatient-rehabilitation-therapy-services-policy-facility.pdf
policy for the services described and is not intended to address every aspect of a reimbursement situation. Accordingly, UnitedHealthcare may use reasonable discretion in interpreting and applying this policy to health care services provided in a particular case. Further, the policy does not address all issues related to reimbursement …
[PDF File] Clinical Diagnostic Laboratory Services
http://5y1.org/file/11211/clinical-diagnostic-laboratory-services.pdf
Laboratory services must meet all applicable requirements of the Clinical Laboratory Improvement Amendments of 1988 (CLIA), as set forth at 42 CFR part 493. Section 1862(a)(1)(A) of the Act provides that Medicare payment may not be made for services that are not reasonable and necessary. Clinical laboratory services must be ordered and …
[PDF File] Home Health Services, Home Health Visits, Respite Care, and …
http://5y1.org/file/11211/home-health-services-home-health-visits-respite-care-and.pdf
Medicare recognizes that determinations of whether home health services are reasonable and necessary must be based on an assessment of each patient’s individual care needs. Therefore, denial of services based on numerical utilization screens, diagnostic screens, diagnosis or specific treatment norms is not appropriate. Refer to the
[PDF File] Bilateral Procedures Policy, Professional
http://5y1.org/file/11211/bilateral-procedures-policy-professional.pdf
instances, use modifier 59 to report the additional units beyond the bilateral services performed indicating that the services were performed on a different site or organ system. Medical record documentation must support the use of modifier 59 or XS. Procedure Codes with the Term "bilateral" in the Description
[PDF File] Habilitation and Rehabilitation Therapy (Occupational, …
http://5y1.org/file/11211/habilitation-and-rehabilitation-therapy-occupational.pdf
Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claim payment. Other Policies and Guidelines may apply.
[PDF File] Consultation Services Policy, Professional
http://5y1.org/file/11211/consultation-services-policy-professional.pdf
This policy addresses the information UnitedHealthcare requires to be submitted with reimbursable consultation services codes and how services rendered at the request of another physician or appropriate source may be reported in lieu of CPT (®) consulta tion services codes 99242-99245 and 99252-99255. Created Date: 3/16/2024 9:03:36 AM
[PDF File] Home Health, Skilled, and Custodial Care Services (for …
http://5y1.org/file/11211/home-health-skilled-and-custodial-care-services-for.pdf
Skilled care services are medically necessary services provided in the member’s Place of Residence by licensed health care professionals and may include services such as medical or psychological evaluation, wound care, medication teaching, pain management, disease education and management, physical therapy, speech therapy, or occupational ...
[PDF File] Cosmetic and Reconstructive Services and Procedures
http://5y1.org/file/11211/cosmetic-and-reconstructive-services-and-procedures.pdf
For coverage guidelines, refer to the UnitedHealthcare Commercial Medical Policy titled Cosmetic and Reconstructive Procedures located in the References section. Abrasion; single lesion (e.g., keratosis, scar) (CPT code 15786). Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure) (CPT code 15787).
[PDF File] Obstetrical Policy, Professional
http://5y1.org/file/11211/obstetrical-policy-professional.pdf
Routine outpatient E/M services provided within 6 weeks of delivery • Postpartum care only • Educational services e.g., breastfeeding, lactation, and basic newborn care UnitedHealthcare will not separately reimburse the above services when reported separately from the global OB code.
[PDF File] Preventive Care Services: Vaccine Codes
http://5y1.org/file/11211/preventive-care-services-vaccine-codes.pdf
Preventive Care Services : Vaccine Codes Page 3 of 13 UnitedHealthcare Commercial & Affiliates and Individual Exchange Policy Appendix: Applicable Code List Last Updated 03/26/2024 Proprietary Information of UnitedHealthcare.
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