As of March 1st, 2021, UnitedHealthcare has made several updates to their reimbursement policy for Advanced Practice Health Care Providers. The previous policy change was made on April 13th, 2020 when the word “Commercial” was added to the policy header.
Important Note: UnitedHealthcare reimbursement policies may use Current Procedural Terminology (CPT®), Centers for Medicare and Medicaid Services (CMS), or other coding guidelines. This specific policy applies to all health care services reported using the 1500 Health Insurance Claim Form (CMS-1500) and, when specified, those billed on UB04 forms.
Overview of Policy
This policy details the requirements for reporting the services of Advanced Practice Health Care Providers and other Nonphysician Providers, within a medical or other healthcare practice. An Advanced Practice Health Care Provider includes:
- Physician Assistants (PA)
- Nurse Practitioners (NP)
- Clinical Nurse Specialists (CNS)
March 2021 Updates
Policy Version Change
New Section Added:
- Reporting of Services by Advanced Practice Health Care Providers
Title and Section Verbiage Changes:
- Reimbursement Guidelines for Advance Practice Health Care Providers with an NPI Number
- Reporting “Incident-to” Services for Advanced Practice Health Care Providers with an NPI Number and other Nonphysician Providers.
- Determining if a Service is “Incident-to” for Split/Shared E/M Services – Advanced Practice Health Care Providers with an NPI Number.
Section Verbiage Changes:
- Overview
Section Removed
- Procedures with Modifier SA Sections
Definitions:
- Added: Advanced Practice Health Care Provider and Nonphysician Provider
- Removed: Collaboration and Modifier SA
Questions and Answers Section:
- #1 Answer verbiage change
- #2 Answer verbiage change
History Section: Entries prior to 1/1/2019 archived
The complete policy and list of changes can be found here.
Coding Education and Training at HIS
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