UHC – Reimbursement Policy Update Bulletin
July 6, 2020United Healthcare Commercial Reimbursement Policy Updates
Summary of Changes
UPDATED: CCI Editing, Professional – Effective 9/1/2020
- Effective with dates of service on or after 9/1/2020, the CCI Editing policy will be improved to more effectively administer NCCI PTP code pair edits with anatomical modifiers.
- This enhancement will require anatomical modifiers on both codes in edits which are applicable to paired body parts. (For a list of anatomical modifiers, see the CCI Editing Policy.)
- The existence of the NCCI PTP edit indicates that the two codes generally cannot be reported together unless the two corresponding procedures are performed at two separate patient encounters or two separate anatomic locations.
- If modifiers are not reported on both codes, UnitedHealthcare will be unable to determine whether or not the services have been performed at two separate encounters or two separate anatomic locations, and the Column 2 code will therefore be bundled into the Column 1 code.
Summary of Changes
UPDATED: Outpatient Hospital,CCI Editing, Facility – Effective 9/1/2020
- Effective with dates of service on or after 9/1/2020, the Outpatient Hospital CCI Editing policy will apply to all network and non-network hospitals. In addition, the policy will apply to all outpatient types of bills that are applicable to these edits with the exception of Critical Access Hospitals.