Effective Sept. 1, UnitedHealthcare will begin requiring prior authorization for physical therapy, occupational therapy, speech therapy and Medicare-covered chiropractic services delivered in multidisciplinary offices and outpatient hospital settings.
The new requirements will exclude services offered in the home, according to an Aug. 14 press release from the insurer.
It will impact patients seeking care in physician offices, on- and off-campus outpatient hospitals, ASCs, independent clinics and outpatient rehab facilities.
The new requirements will apply to UnitedHealthcare Medicare Advantage nationally. Current prior authorization requirements in Arkansas, Georgia, South Carolina and New Jersey for outpatient therapies will continue as previously deployed and will now include Medicare-covered chiropractic services.
Impacted procedure codes will include:
Outpatient therapies: 92507, 92508, 92526, 97012, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97139, 97140, 97150, 97164, 97168, 97530, 97533, 97535, 97537, 97542, 97545, 97546, 97750, 97755, 97760, 97761, 97799, G0283
Chiropractic services (Medicare-covered): 98940, 98941, 98942 when billed with the AT-modifier