Effective Date: 01.01.2021 – This policy addresses diagnostic and therapeutic procedures for infertility and cryopreservation. Effective Date: 01.01.2021 – This policy addresses the use of cranial orthotic devices for treating infants with plagiocephaly and craniosynostosis. Applicable Procedures Codes: 93653, 93655, 93656, 93657. Applicable Procedure Codes: 95700, 95711, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95722, 95724, 95726. Effective Date: 04.01.2020 – This policy addresses cognitive rehabilitation and coma stimulation. Access a policy listed below for complete details on the latest updates. Applicable Procedure Codes: J0180, J0221, J1322, J1458, J1743, J1931, J2840, J3397, J3590. Effective Date: 12.01.2020 – This policy addresses fecal measurement of calprotectin. Effective Date: 12.01.2020 – This policy addresses the use of Luxturna™ (voretigene neparvovec-rzyl) for the treatment of inherited retinal dystrophies (IRD) caused by mutations in the retinal pigment epithelium-specific protein 65kDa (RPE65) gene. Effective Date: 05.01.2020 – This policy addresses chemotherapy observation or overnight (inpatient) stay. Applicable Procedure Codes: C9399, J3490, J3590. US Health Policy—2020 and Beyond: Introducing a New JAMA Series. Effective Date: 01.01.2021 – This policy addresses the use of low-load prolonged-duration stretch devices, static progressive (SP) stretch splint devices, and patient actuated serial stretch (PASS) devices. 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Applicable Procedure Codes: 62263, 62264, 62290, 62290, 64999, 72285, 72295. Applicable Procedure Codes: 97605, 97606, 97607, 97608, A6550, A9272, E2402. They represent a portion of the resources used to support UnitedHealthcare coverage decision making. Effective Date: 07.01.2020 – This policy addresses skilled care and custodial care services. The Centers for Disease Control and Prevention and state health departments are advising who can get the vaccines and when. Effective Date: 02.01.2021 – This policy addresses the use of provider-administered Ilumya™ (tildrakizumab-asmn) for the treatment of moderate to severe plaque psoriasis. Effective Date: 10.01.2020 – This policy addresses the use of C1 esterace inhibitors (human), C1 esterace inhibitors (recombinant), and plasma kallikrein inhibitors (human) for the treatment and prophlaxis of hereditary angioedema (HAE). Effective Date: 11.01.2020 – This policy addresses the use of Krystexxa® (pegloticase) for treatment of chronic gout refractory to conventional therapy. UMR is a third-party administrator (TPA), hired by your employer, to help ensure that your claims are paid correctly so that your health care costs can be kept to a minimum and you can focus on well-being. Effective Date: 01.01.2021 – This policy addresses the use of Zolgensma® (onasemnogene abeparvovec-xioi) for the treatment of spinal muscular atrophy (SMA). %%EOF Applicable Procedure Codes: 20930, 20931, 20932, 20933, 20934, 22558, 22585, 22899. Effective Date: 07.01.2020 – This policy addresses the use of Stelara® (ustekinumab) for the treatment of Crohn’s disease, plaque psoriasis, psoriatic arthritis, and ulcerative colitis. Health insurers have seen an overall drop in medical costs due to Covid-19, which could result in record premium rebates for 2020, under the Affordable Care Act. Applicable Procedure Codes: J1745, Q5103, Q5104, Q5109, Q5121. Effective Date: 10.01.2020 – This policy addresses the use of Orencia® (abatacept) injection for intravenous infusion for the treatment of polyarticular juvenile idiopathic arthritis, rheumatoid arthritis, psoriatic arthritis, chronic graft-versus-host disease, and immune checkpoint inhibitor-related toxicities. Effective Date: 11.01.2020 – This policy addresses the SynCardia™ temporary Total Artificial Heart. UnitedHealthcare Connected™ (Medicare-Medicaid Plan) UnitedHealthcare Connected (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. Applicable Procedure Code: J2350. The information presented in these policies and guidelines is believed to be accurate and current as of the date of publication and is provided on an "AS IS" basis. Applicable Procedure Code: J3241. The appearance of a health service (e.g., test, drug, device or procedure) in the Medical Policy Update Bulletin does not imply that UnitedHealthcare provides coverage for the health service. Applicable Procedure Codes: 43210, 43257, 43284, 43289, 43499, 43999. Good for you. Effective Date: 01.01.2021 – This policy addresses breast repair/reconstruction not following mastectomy. Applicable Procedure Code: 93580. Applicable Procedure Code: 83993. Robotic Assisted Surgery Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans. You will be able to view your eligibility and general plan information. Applicable Procedure Codes: 92065, 92499. UMR is not an insurance company. Applicable Procedures Codes: 0054T, 0055T, 20985. Effective Date: 10.01.2020 – This policy addresses nonsurgical and surgical treatment of obstructive sleep apnea (OSA). Members should always consult their physician before making any decisions about medical care. Effective Date: 07.01.2020 – This policy addresses surgical repair of pectus excavatum and pectus carinatum. Access our medical policies online. h�b```���b@��(���q�cr0�љ .F��[�'�?���h`���` u@%�O+��˂5�2���|�b"�઄º���+�Nt8/�e��)>�tL�;��^��� OOrr�w�j�������a �v'7�� t�$ȽL����pDc@� ��-t Our selection of individual and family health insurance plans offers you the perfect coverage. Policy … Applicable Procedure Codes: 0342T, 36511, 36512, 36513, 36514, 36516, 36522, S2120. Applicable Procedure Code: J9219. Applicable Procedure Code: J0896. Effective Date: 01.01.2021 – This policy addresses surgical treatment for spine pain. Applicable Procedure Code: J3245. Effective Date: 01.01.2021 – This policy addresses autologous (sural) and allogenic nerve grafts to restore erectile function during or after radical prostatectomy. United Healthcare Medical Policy Updates – April 2020 . Applicable Procedure Codes: 86704, 86705, 86706, 86707, 86708, 86709, 86803, 86804, 87340, 87341, 87350, 87902, 87912, G0472, G0499. Effective Date: 07.01.2020 – This policy addresses private duty nursing (PDN) services. 0 Coding Corner Can Help. Effective Date: 12.01.2020 – This policy addresses hip resurfacing and replacement surgery (arthroplasty). Effective Date: 05.01.2020 – This policy addresses the use of Entyvio® (vedolizumab) for the treatment of Crohn's disease, ulcerative colitis, and immune checkpoint inhibitor-related toxicities. Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, S8990. Applicable Procedure Codes: J0596, J0597, J0598, J1290. Effective Date: 08.01.2020 – This policy addresses meniscus allograft transplantation with human cadaver tissue and collagen meniscus implants. They are also used to decide whether a given health service is medically necessary. Effective Date: 08.01.2020 – This policy addresses bone or soft tissue healing and fusion enhancement products/systems. Last Published 01.04.2021. Effective Date: 07.01.2020 – This policy addresses preimplantation genetic testing (PGT). Effective Date: 10.01.2020 – This policy addresses implanted electrical stimulator for spinal cord. Effective Date: 01.01.2021 – This policy addresses prosthetic devices, specialized/computerized/myoelectric limbs, and wigs, and includes applicable procedure codes for breast prosthesis, ear/eye/nose/facial prosthesis, lower and upper limb prosthetics, additions to upper extremity, prosthetic socks, repairs and replacements, and wigs. Applicable Procedure Code: 97533. Learn more about a Summary of Benefits and Coverage, also commonly referred to as an SBC. Provider Advisory Committee Approval - July 24, 2019 ... 11/12/2020… To view your benefit or claim information, simply enter the required information. 2020 UHC of NV POS Benefit Schedule. Applicable Procedure Codes: S0190, S0191. Effective Date: 05.01.2020 – This policy addresses manipulation under anesthesia (MUA). Effective Date: 01.01.2021 – This policy addresses outpatient emergency health care services, physician-ordered emergency department visits, and urgent care center services. Applicable Procedure Code: 42699. Effective Date: 02.01.2021 – This policy addresses the use of erythropoiesis-stimulating agents (ESAs), including Aranesp® (darbepoetin alfa), Epogen® (epoetin alfa), Mircera® (methoxy polyethylene glycol-epoetin beta [MPG-epoetin beta]), Procrit® (epoetin alfa), and Retacrit™ (epoetin alfa). 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Effective Date: 05.01.2020 – This policy addresses the use of Parsabiv® (etelcalcetide) for the treatment of secondary hyperparathyroidism with chronic kidney disease. UnitedHealthcare … Effective Date: 02.01.2021 – This policy addresses the use of interleukin-5 (IL-5) antagonists, including Cinqair® (reslizumab), Fasenra® (benralizumab), and Nucala® (mepolizumab). Applicable Procedures Codes: C9071, J3490, J3590. The Centers for Disease Control and Prevention and state health departments are … Health Details: Click here to view the United Healthcare Medical Policy Updates » Policy Alerts monitors Commercial and Medicare medical policies for changes.While medical Insurance carriers typically update medical policies annually, there are many reasons why they might review or update a policy. Effective Date: 01.01.2021 – This policy addresses computed tomographic colonography. Same Day / Same Service Policy - Reimbursement Policy - UnitedHealthcare … 2020 UHC of NV HMO Benefit Schedule. Applicable Procedure Code: J1602. Applicable Procedure Codes: 0012U, 0013U, 0014U, 0036U, 0094U, 0212U, 0213U, 0214U, 0215U, 81415, 81416, 81417, 81425, 81426, 81427. Effective Date: 03.01.20121 – This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems. Effective Date: 12.01.2020 – This policy addresses the use of Evenity® (romosozumab- aqqg) for the treatment of osteoporosis in postmenopausal patients at high risk for fracture. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879. Applicable Procedure Codes: J0517, J2182, J2786. Applicable Procedure Codes: J1459, J1555, J1556, J1557, J1558, J1559, J1561, J1566, J1568, J1569, J1572, J1575, J1599, J3590. Applicable Procedure Codes: C9399, J0129, J0180, J0221, J0222, J0223, J0256, J0257, J0490, J0584, J0638, J0717, J0791, J0896, J1300, J1301, J1303, J1322, J1428, J1429, J1458, J1602, J1743, J1745, J1746, J1786, J1931, J2840, J3032, J3060, J3241, J3245, J3262, J3357, J3358, J3380, J3385, J3397, J3490, Q5103, Q5104, Q5121. Effective Date: 02.01.2021 – This policy addresses advanced radiologic imaging procedures performed in a hospital outpatient department. Applicable Procedures Code: J1429. 490 0 obj <>/Filter/FlateDecode/ID[<7DC03E753AD95F40829EDED02351250C>]/Index[460 55]/Info 459 0 R/Length 128/Prev 71159/Root 461 0 R/Size 515/Type/XRef/W[1 2 1]>>stream Effective Date: 04.01.2020 – This policy addresses home hemodialysis (HHD). Effective Date: 01.01.2021 – This policy addresses durable medical equipment (DME), orthotics, ostomy supplies, medical supplies and repairs/replacements. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941. Effective Date: 11.01.2020 – This policy addresses electrical bioimpedance for cardiac output measurement. Explore employer, individual & family, Medicare-Medicaid health insurance plans from UnitedHealthcare. Effective Date: 05.01.2020 – This policy addresses clinical trials. Effective Date: 02.01.2021 – This policy addresses parameters for coverage of injectable oncology medications. Applicable Procedure Codes: 0278T, 63650, 63655, 63685, 64999, E0744, E0745, E0762, E0764, E0770, E1399, L8679, L8680, L8682, L8685, L8686, L8687, L8688, S8130, S8131. Applicable Procedure Codes: J0178, J0179, J2503, J2778, J9035, Q5107, Q5118. Effective Date: 04.01.2020 – This policy addresses transarterial radioembolization (TARE) using yttrium-90 (90Y) microspheres for the treatment of malignant tumors. Effective Date: 05.01.2020 – This policy addresses embolization of the ovarian or internal iliac veins. Effective Date: 02.01.2021 – This policy addresses apheresis/therapeutic apheresis. Applicable Procedure Codes: E0769, G0281, G0282, G0295, G0329. Applicable Procedure Codes: J0881, J0882, J0885, J0887, J0888, Q4081, Q5105, Q5106. Effective Date: 01.01.2021 – This policy addresses DNA-based noninvasive prenatal tests. Applicable Procedure Code: J3380. 2020 UHC of NV HMO Benefit Schedule. Your employer pays the portion of your health care costs not paid by you. Travel Health Insurance, Property & Casualty, Final Expense Whole Life Insurance and Pet Insurance are underwritten by different companies that are not related to the UnitedHealthcare family of companies. 2020 UHC of NV Prescription Drug Rider of HMO and POS Plans. Effective Date: 02.01.2021 – This policy addresses vertebral body tethering for the treatment of scoliosis. Effective Date: 04.01.2020 – This policy addresses elbow replacement surgery (arthroplasty). Effective Date: 12.01.2020 – This policy addresses the use of intravenous enzyme replacement drug products for the treatment of Gaucher disease, including Cerezyme® (imiglucerase), Elelyso® (taliglucerase), and VPRIV® (velaglucerase). 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Applicable Procedure Code: J0490. Effective Date: 01.01.2021 – This policy addresses nerve conduction studies and other neurophysiological testing. Effective Date: 11.01.2020 – This policy addresses review of certain new to market medications that are healthcare provider administered. In the event of an inconsistency or conflict between the information provided in the Medical Policy Update Bulletin and the posted policy, the provisions of the posted policy will prevail. Applicable Procedure Codes: 38205, 38206, 38207, 88240, S2140. Effective Date: 10.01.2020 – This policy addresses the use of Synagis® (palivizumab) to prevent serious respiratory syncytial virus disease (RSV) in high risk infants and young children. Effective Date: 12.01.2020 – This policy addresses thermal intradiscal procedures (TIPs) and percutaneous discectomy and decompression procedures for treating discogenic pain, and annulus fibrosus repair following spinal surgery. Applicable Procedure Codes: 0068U, 87480, 81513, 81514, 87481, 87482, 87510, 87511, 87512, 87660, 87661, 87797, 87798, 87799, 87800, 87801. In June 2019, UnitedHealthcare announced the launch of UnitedHealthcare Hearing, which it said would offer “all consumers, including people enrolled in the company’s individual, employer-sponsored and Medicare Advantage plans, greater access to affordable, quality hearing health”.. UnitedHealthcare … Applicable Procedure Code: J0584. Applicable Procedure Codes: 55899, 64999. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33418, 33419, 33477, 33999, 93799. GRP 79171 GPS-1 (G-36000-4). Effective Date: 10.14.2020 – This policy addresses hepatitis screening. Effective Date: 03.01.2021 – This policy addresses the use of Xolair® (omalizumab) for subcutaneous use for the treatment of moderate to severe persistent asthma, chronic urticaria, and nasal polyps. Effective Date: 11.01.2020 – This policy addresses enzyme replacement therapy, including the use of Aldurazyme (laronidase), Elaprase (idursulfase), Fabrazyme (agalsidase beta), Kanuma (sebelipase alfa), Lumizyme (alglucosidase alfa), Mepsevii (vestronidase alfa-vjbk), Naglazyme (galsulfase), Revcovi (elapegademase-lvlr), and Vimizim (elosulfase alfa). This document is a listing of MPUBs published in 2020 and 2019. Unauthorized copying, use, and distribution of this information are strictly prohibited. Applicable Procedure Codes: J7170, J7175, J7177, J7178, J7179, J7180, J7181, J7182, J7183, J7185, J7186, J7187, J7188, J7189, J7190, J7192, J7193, J7194, J7195, J7198, J7199, J7200, J7201, J7202, J7203, J7204, J7205, J7207, J7208, J7209, J7210, J7211, J7212. Insured by UnitedHealthcare Insurance Company, Horsham, PA (UnitedHealthcare Insurance Company of New York, Islandia, NY for New York residents).
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