UnitedHealthcare has recently introduced new clinical guidelines for surgical and pain management services. Healthcare providers should expect to receive pre-payment requests for medical records starting from the dates of service on or after March 1, 2022.
First, the following services are now deemed not medically necessary by UnitedHealthcare:
• Interferential therapy (IFT) for treating musculoskeletal disorders/injuries, or to facilitate healing of nonsurgical soft tissue injuries or bone fractures• Microcurrent electrical nerve stimulation (MENS)• Percutaneous electrical nerve stimulation (PENS), percutaneous electrical nerve field stimulation (PENFS) or percutaneous neuromodulation therapy (PNT)• Percutaneous peripheral nerve stimulation (PNS)• Peripheral subcutaneous field stimulation (PSFS) or peripheral nerve field stimulation (PNFS)• Pulsed electrical stimulation (PES)• Scrambler Therapy (ST)• Translingual Stimulation for gait rehabilitation (TS)
Please click
here to see a full list of affected CPT codes (page 3).
Second, arthroscopy procedures are now included into the general clinical policy covering surgeries of hip. The following procedure codes are affected:
• 29860 – arthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure)• 29861 – arthroscopy, hip, surgical; with the removal of the loose body or foreign body• 29862 – arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of the labrum• 29863 – arthroscopy, hip, surgical; with synovectomy
You can find a full list of clinical information that needs to be indicated in the medical records for these 4 procedures here.
Source:
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