Insurance Company Updates
Several insurance companies have made note-worthy updates to their billing policies.
Superior HealthPlan
- Effective June 1, 2022, the criteria for the assessment and treatment of Attention Deficit Hyperactivity Disorder (ADHD) has been revised and updated. More than a dozen CPT codes have been deemed not medically necessary when billed with a sole diagnosis of ADHD. The full list can be found here: https://www.superiorhealthplan.com/newsroom/effective006012022-clinical-payment-policy-revision-adhd-assessemt-and-treatment.html
UnitedHealthcare
- UnitedHealthcare has made several updates or changes to its medical policy for March 2022. Some of the changes include, but are not limited to:
Commercial Policies: cardiovascular disease risk testing, negative pressure wound therapy, and durable medical equipment repairs/replacements. The full list of updates for UHC commercial plans can be found here: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/mpub-archives/commercial/medical-policy-update-bulletin-march-2022.pdf
Community Plan: functional endoscopic sinus surgery, whole exome and whole genome sequencing, and durable medical equipment repairs/replacements. The full list of updates for UHC community plans can be found here: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/mpub-archives/comm-plan/community-plan-medical-policy-update-bulletin-march-2022.pdf
Medicare Advantage Plans: diabetes supplies, oxygen for home use, and Telehealth services. Another update for Medicare Advantage plans includes the addition of more than 50 outpatient surgical procedures requiring site of service medical necessity review. All UHC Medicare Advantage policy updates can be found here: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/mpub-archives/macs/medicare-advantage-coverage-summary-update-bulletin-march-2022.pdf
About PGM
Physicians Group Management (PGM) is one of the fastest-growing medical billing companies in the United States. For over 35 years, PGM has been providing medical billing and practice management services and software to physicians, healthcare facilities, and laboratories. PGM’s current client base encompasses the full spectrum of medical specialties, including Internal Medicine, Dermatology, Plastic & Reconstructive Surgery, Pathology, EMS & Ambulatory Services, Cardiology, Nephrology, Urology, Pain Management, OB/GYN, Gastroenterology, Independent Laboratory, and many more. PGM’s medical billing and practice management solutions include: –
- A full suite of practice management and medical billing solutions each tailored to the specific needs of your practice
- CCHIT-certified electronic medical record software and services
- Streamlined, customized credentialing services for providers of all sizes
- Practice management software that provides advanced financial and practice analysis tools, specifically designed to give enhanced visibility of operations at the click of a button
- Laboratory billing software that offers best-in-class systems to streamline, and manage and track, financial and administrative processes