In July, UHC announced it would discontinue reimbursement for G2211 for commercial plans as of Sept. 1. The ACR led a multispecialty sign-on letter urging the payer to reconsider its decision to help ensure clinicians can maintain the additional work needed to manage complex and chronic diseases.
UHC Updates Policy on Reimbursement for Incident-to Services
On Aug. 1, UnitedHealthcare implemented a new policy on Services Incident-to a Supervising Health Care Provider that allows for appropriate reimbursement for “incident-to” services consistent with current Medicare guidelines.
UnitedHealthcare Designates Avsola, Inflectra Preferred Infliximab Products
On Feb. 1, UnitedHealthcare enacted a new policy designating Avsola and Inflectra as the preferred infliximab products for UHC commercial plans. ACR leaders have urged UHC to allow existing patients to continue on their current medication.
UnitedHealthcare Delays Copay Accumulator Policy
After ACR and other provider and patient organizations expressed concerns about a proposed copay accumulator policy set to take effect Jan. 1, 2021, UnitedHealthcare has indefinitely delayed its implementation but is continuing to explore options to reduce spending on specialty drugs.
UHC Updates Rituximab Policy to Require Use of Biosimilars
As of Oct. 1, UnitedHealthcare (UHC) requires that patients fail to respond to both FDA-approved rituximab biosimilars prior to receiving approval for rituximab. Exception: Rituximab-pvvr (Ruxience) is not FDA approved for rheumatoid arthritis.
UHC Announces New Copay Accumulator Policy Affecting In-Office Treatments
Editor’s note Nov. 23, 2020: As of Nov. 12, 2020, UHC has delayed implementation of the policy discussed below. See “UnitedHealthcare Delays Copay Accumulator Policy.” UnitedHealthcare (UHC) announced that, as of Jan. 1, 2021, providers will be required to report the amount their patients receive in copay assistance for office-administered treatments. UHC will then use…
UnitedHealthCare Rescinds Planned Changes to Orencia Policy
UnitedHealthcare (UHC) is rescinding changes to its Orencia policy previously scheduled to go into effect July 1, 2020. These changes would have required patients to fail to respond to the self-administered formulation of the drug prior to obtaining authorization for the physician-administered product. Some patients on Orencia received notices from UHC in late April stating…
UnitedHealthcare to Implement Fail-First Requirement for Self-Administered Orencia
On April 1, UnitedHealthcare (UHC) announced updates to its Orencia policy, effective July 1, 2020. The change requires patients to fail to respond to the self-administered formulation of this drug prior to obtaining authorization for the physician-administered product. The ACR has been in communication with UHC about this policy since October 2019, when the payer…
ACR Urges Commercial Payers to Provide Relief from Prior Authorizations, Practice Disruptions
The ACR is urging insurance companies to expand access to telehealth services and provide relief from administrative burdens to help providers focus on patient care at this critical time.
Reimbursement Options for Services Without Direct Patient Contact
Beginning in October 2019, two major commercial payers, UnitedHealthcare and Cigna, discontinued payment for consultation services. The CPT codes affected include 99241–99245 and 99251–99255. The payers have instructed providers to instead bill the non-consultative evaluation and management (E/M) codes that best describe the services performed. If the non-face-to-face service goes beyond the usual time a…