UnitedHealthcare community plan policies and guidelines for healthcare professionals. Applicable Procedure Codes: 0060U, 0327U, 81420, 81422, 81479, 81507. Applicable Procedure Code: J3032. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options (SCO) program. The information provided through this service is for informational purposes only. If youve visited CityMD before, well have some of your information already and you will be asked to confirm information on your record. Applicable Procedure Codes: 0308T, 67036, 67299, 92499. Applicable Procedure Code: 19300. Applicable Procedure Code: J2357. I received a letter about changes to my Medicaid insurance coverage. I had an exceptionally good experience here. Effective Date: 07.01.2023 This policy addresses thermal intradiscal procedures (TIPs) and percutaneous discectomy and decompression procedures for treating discogenic pain, and annulus fibrosus repair following spinal surgery. Specific care and treatment may vary depending on individual need and the benefits covered under your contract. Find a doctor, medical specialist, mental health care provider, hospital or lab. Access to specialists may be coordinated by your primary care physician. Effective Date: 12.01.2022 This policy addresses closure (occlusion) of the left atrial appendage (LAA). Effective Date: 04.01.2023 This policy addresses the use of Enjaymo (sutimlimab-jome) for the treatment of cold agglutinin disease (CAD). Yes, each of our locations have X-ray machines on-site, staffed by certified X-ray technicians. Effective Date: 01.01.2023 This policy addresses clinical trials. Individual & Family ACA Marketplace plans | UnitedHealthcare Effective Date: 07.01.2023 This policy addresses preimplantation genetic testing (PGT). For more information contact the plan or read the Member Handbook. Applicable Procedure Codes: 38205, 38206, 38207, 88240, S2140. Effective Date: 04.01.2023 This policy addresses percutaneous vertebroplasty and kyphoplasty for treating spinal pain. Applicable Procedure Codes: 0029U, 0078U, 0173U, 0175U, 0286U, 0290U, 0291U, 0292U, 0293U, 0345U, 0347U, 0348U, 0349U, 0350U, 0380U, 0392U, 81418, 81479. Effective Date: 01.01.2023 This policy addresses breast imaging, including digital mammography, magnetic resonance imaging (MRI), ultrasound, automated breast ultrasound system, computer-aided detection (CAD), computer-aided tactile breast imaging, electrical impedance scanning (EIS), magnetic resonance elastography (MRE), and molecular breast imaging. We offer a wide range of plans designed for: Were Americas dual-eligible plan leader1. Effective Date: 06.01.2023 This policy addresses liposuction for lipedema when used to treat functional impairment. "Utilizing an out-of-network provider may result in higher costs for you," United wrote. Information to clarify health plan choices for people with Medicaid and Medicare. It's simple, secure and free. Medicaid Providers: UnitedHealthcare will reimburse out-of-network providers for COVID-19 testing-related visits and COVID-19 related treatment or services according to the rates outlined in the Medicaid Fee Schedule. Applicable Procedure Codes: 21073, 22505, 23700, 25259, 26340, 27198, 27275, 27570, 27860, D7830. Medicare Advantage plans are required to spend a minimum of 85% of premium dollars on medical expenses; failure to do so for three consecutive years triggers the sanctions. Applicable Procedure Codes: 0424T, 0425T, 0426T, 0427T, 0428T, 0429T, 0430T, 0431T, 0432T, 0433T, 0434T, 0435T, 0436T, 21142, 21199, 21206, 21685, 41512, 41530, 41599, 42145, 42299, 64553, 64568, 64569, 64570, 64582, 64583, 64584, A7049, E0485, E0486, E1399, K1001, K1027, K1028, K1029, L8679, L8680, L8686, S2080, S2900. Effective Date: 03.01.2023 This policy addresses glaucoma drainage devices/stents, canaloplasty, and gonioscopy-assisted transluminal trabeculotomy. This means UnitedHealthcare Community Plan is no longer accepted by Duke doctors or at Duke clinics or hospitals. Get health plan information - just for you. Effective Date: 07.01.2023 This policy addresses the use of Ketalar (ketamine) for anesthesia purposes and Spravato (esketamine) for the treatment of treatment-resistant depression (TRD) and major depressive disorder (MDD). Applicable Procedure Code: 93701. Look here atMedicaid.gov. Effective Date: 01.01.2023 This policy addresses non-hybrid and hybrid cochlear implantation. Applicable Procedure Code: J1428. New York UnitedHealthcare Community Plan Find a provider or pharmacy, UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan), UnitedHealthcare Connected (Medicare-Medicaid Plan), UnitedHealthcare Connected for One Care (Medicare-Medicaid Plan), UnitedHealthcare Connected general benefit disclaimer, UnitedHealthcare Senior Care Options (HMO SNP) Plan, Medicare dual eligible special needs plans, Orange, Rockland, Ulster and Westchester Counties, Use this tool to search our network of dentists, https://member.emedny.org/pharmacy/search-locations, provider_directory_invalid_issues@uhc.com, Non-Discrimination Language Assistance Notices. Effective Date: 07.01.2023 This policy addresses mastectomy or suction lipectomy for the treatment of benign gynecomastia. Applicable Procedure Code: J0584. Effective Date: 10.01.2022 This policy addresses the use of Soliris (eculizumab) and Ultomiris (ravulizumab-cwvz). Effective Date: 06.01.2023 This policy addresses whole exome and whole genome sequencing. UnitedHealthcare Community Plan Plastic Surgeons Near Me What are the credentials of CityMD doctors? Effective Date: 07.01.2023 This policy addresses the use of Lemtrada (alemtuzumab) for treatment of relapsing forms of multiple sclerosis. Easy access to plan information anytime anywhere. Applicable Procedure Codes: C9399, J3490, J3590. We do not guarantee that each provider is still accepting new members. Effective Date: 03.01.2023 This policy addresses virtual upper gastrointestinal endoscopy. UnitedHealthcare Connected for One Care (Medicare-Medicaid Plan) is a health plan that contracts withboth Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. May I pre-register for others besides myself (ie. Effective Date: 01.01.2023 This policy addresses the use of Xiaflex (collagenase clostridium histolyticum) for the treatment of Dupuytrens contracture and Peyronies disease. Applicable Procedure Codes: A0225, A0380, A0382, A0384, A0390, A0392, A0394, A0396, A0398, A0420, A0422, A0424, A0425, A0426, A0427 A0428, A0429, A0430, A0431, A0432, A0433, A0434, A0435, A0436, A0998, A0999, S9960, S0207, S0208, S9960, S9961, T2007. Applicable Procedure Code: 42699. Effective Date: 07.01.2023 This policy addresses the use of infliximab products, including Avsola (infliximab-axxq), Inflectra (infliximab-dyyb), Remicade (infliximab), and Renflexis (infliximab-abda). UnitedHealthcare Community & State Effective Date: 05.01.2023 This policy addresses the medical necessity of certain planned surgical procedures when performed in a hospital outpatient department. Effective Date: 07.01.2023 This policy addresses arterial compliance testing using waveform analysis, carotid intima-media thickness (CIMT) measurement, advanced lipoprotein analysis, endothelial function assessment, and tests for lipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme, other human A2 phospholipases, and long-chain omega-3 fatty acids. Effective Date: 04.01.2023 This policy addresses bariatric surgical procedures, including gastric bypass, gastric banding, sleeve gastrectomy, biliopancreatic bypass, and biliopancreatic diversion with duodenal switch. Resource Center Duke Health's relationship with UnitedHealthcare Community Plan expired on October 15, 2022. Applicable Procedure Codes: 20605, 20606, 20610, 20611, J3490, J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, J7331, J7332. 2023 UnitedHealthcare Services, Inc. All rights reserved. Applicable Procedure Codes: L6026, L6611, L6621, L6629, L6632, L6677, L6680, L6682, L6686, L6687, L6688, L6694, L6695, L6696, L6697, L6698, L6715, L6880, L6881, L6882, L6883, L6884, L6890, L6925, L6935, L6945, L6955, L6975, L7007, L7008, L7009, L7045, L7180, L7181, L7190, L7191, L7259, L7360, L7364, L7366, L7367, L7368, L7400, L7401, L7403, L7404, L8465. Applicable Procedure Codes: 20930, 20931, 20939, 22899. Applicable Procedure Codes: 86704, 86705, 86706, 86707, 86708, 86709, 86803, 86804, 87340, 87341, 87350, 87902, 87912, G0472, G0499. Enrollment in the plan depends on the plans contract renewal with Medicare. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879. Effective Date: 07.01.2023 This policy addresses the use of Entyvio (vedolizumab) for the treatment of Crohn's disease, ulcerative colitis, and immune checkpoint inhibitor-related toxicities. Copyright 2010 - 2023 Summit Health Management, LLC. Benefits Effective Date: 03.01.2023 This policy addresses sensory integration therapy and auditory integration training. Here are answers to frequently asked questions you may have. Applicable Procedure Codes: 59072, 59074, 59076, 59897, S2400, S2401, S2402, S2403, S2404, S2405, S2409, S2411. Applicable Procedure Codes: 0278T, 0720T, 63650, 63655, 63663, 63664, 63685, 64555, 64999, A4556, A4557, A4558, A4595, A4630, E0720, E0730, E0731, E0744, E0745, E0762, E0764, E0770, E1399, K1023, L8679, L8680, L8682, L8685, L8686, L8687, L8678, L8688, S8130, S8131. Applicable Procedure Codes: 29868, G0428. This Community Plan medical policy library does not apply to the following states; click the link to view the applicable Medical & Drug Policies and Coverage Determination Guidelines: ForLouisiana, clickhereto view MCG criteria for the top Outpatient procedures and Admission diagnoses. View the benefits below to see all that our Tennessee Medicaid plan offers. If you dont see an answer to your question, contact us. Applicable Procedure Codes: 22853, 22854, 22859, 22867, 22868, 22869, 22870, 22899, C1821. Then select NY COMMUNITY PLAN MEDICAID/CHP/FHP to find providers in your area. Applicable Procedure Code: J1429. Do not submit protected health information using this form. Effective Date: 06.01.2023 This policy addresses home traction therapy. Effective Date: 02.01.2023 This policy addresses functional endoscopic sinus surgery (FESS). Effective Date: 11.01.2022 This policy addresses breast reduction surgeries. Enrollment in the plan depends on the plans contract renewal with Medicare. Looking for another type of Medicare plan? Effective Date: 07.01.2023 This policy addresses the use of Trogarzo (ibalizumab-uiyk) for the treatment of multi-drug resistant human immunodeficiency virus (HIV). Highly recommended Paul Trites, MD Ophthalmologist Bobtown, VA 4.83 ( 6 reviews) Questions? Effective Date: 05.01.2023 This policy addresses the use of low-load prolonged-duration stretch devices, static progressive (SP) stretch splint devices, and patient actuated serial stretch (PASS) devices. This information is intended to serve only as a general reference resource regarding UnitedHealthcare Community Plans reimbursement policy for the services described and is not intended to address every aspect of a reimbursement situation. Resource Center Effective Date: 07.01.2023 This policy addresses pediatric gait trainers and standing systems. CityMD agrees to deal with UnitedHealthcare - Crain's New York Business Applicable Procedure Codes: 76497, 76498. In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities. In the event of a conflict, the member specific benefit plan document supersedes these policies and guidelines. Effective Date: 01.01.2023 This policy addresses spinal and paraspinal ultrasonography. Applicable Procedure Code: J2507. Khang T. Vuong, MHA 24 Jun 2023. CityMD strikes deal to stay in-network with UnitedHealthcare Applicable Procedure Codes: 15877, 15878, 15879. A Few Simple Rules UnitedHealthcare Community Plan's Facebook page is an interactive space where we can connect and share. Effective Date: 07.01.2023 This policy addresses the use of Stelara (ustekinumab) for the treatment of Crohns disease, plaque psoriasis, psoriatic arthritis, and ulcerative colitis. Walk in when you need us With 160 locations across NY and NJ and on-demand access to virtual care, we'll take care of you. Applicable Procedure Codes: E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E1054, E1055, E0156, E1057, E0158, E0159. Effective Date: 03.01.2023 - This policy addresses virtual upper gastrointestinal endoscopy. Effective Date: 05.01.2023 This policy addresses deep brain stimulation and responsive cortical stimulation. Applicable Procedure Codes: 0253T, 0449T, 0450T, 0474T, 0671T, 65820, 66174, 66175, 66179, 66180, 66183, 66184, 66185, 66989, 66991, C1889, L8612. New York UnitedHealthcare Community Plan Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999. UnitedHealthcare Community Plan Chiropractors Near Me 2023 UnitedHealthcare Services, Inc. All rights reserved. Find a Provider Find a pharmacy Find a local pharmacy that's convenient for you. Effective Date: 02.01.2023 This policy addresses private duty nursing services. Why we're different. Effective Date: 01.01.2023 This policy addresses extracorporeal shock wave therapy (ESWT) for musculoskeletal and soft tissue conditions. Physical or other therapy to help you be your best. Applicable Procedure Codes: 59074, 59076, 59897, S2400, S2401, S2402, S2403, S2404, S2405, S2409, S2411. Effective Date: 07.01.2023 This policy addresses the use of intravenous enzyme replacement drug products for the treatment of Gaucher disease, including Cerezyme (imiglucerase), Elelyso (taliglucerase), and VPRIV (velaglucerase). Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950. Effective Date: 07.01.2023 This policy addresses off-label and unproven indications of FDA-approved injectable specialty drugs. Effective Date: 07.01.2023 This policy addresses upper and lower eyelid blepharoplasty, upper eyelid blepharoptosis repair, brow ptosis, eyelid surgery with an anophthalmic socket, ectropion or punctal eversion, entropion, lid retraction surgery, canthoplasty/canthopexy, and repair of floppy eyelid syndrome (FES). Applicable Procedure Codes: J0256, J0257. Effective Date: 07.01.2023 This policy addresses the use of Orencia (abatacept) injection for intravenous infusion for the treatment of polyarticular juvenile idiopathic arthritis, rheumatoid arthritis, psoriatic arthritis, chronic graft-versus-host disease, and immune checkpoint inhibitor-related toxicities. Answer a few quick questions to see what type of plan may be a good fit for you. Applicable Procedure Codes: 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400. Effective Date: 07.01.2023 This policy addresses multiple services/procedures. Effective Date: 11.01.2022 This policy addresses Saphnelo (anifrolumab-fnia) for the treatment of moderate to severe systemic lupus erythematosus (SLE). Thats why we accept most insurance plans, including Managed Medicaid and Medicare plans. Effective Date: 01.01.2023 This policy addresses collection and storage of umbilical cord blood. What does it take to qualify for a dual health plan? Applicable Procedure Codes: 81412, 81443, 81479. To submit new or additional clinical evidence pertaining to a specific medical policy, click here to complete a form for UnitedHealthcare Medical Policy review. People living with disabilities or other serious health conditions. Frequently asked questions Effective Date: 12.01.2022 This policy addresses panniculectomy, abdominoplasty, lipectomy, repair of diastasis recti, and suction-assisted lipectomy. Effective Date: 06.01.2023 This policy addresses outpatient habilitation, rehabilitation and maintenance therapy. Effective Date: 03.01.2023 This policy addresses home health, skilled, and custodial care services. (212) 210-0100, Judge hits pause on Medicare Advantage switch before Monday opt-out deadline, Hospitals are falling short of compliance with safe staffing laws, nurses union says, City had limited success connecting people to shelters, comptroller says, Sponsored Content: On the road to discoveries, How to protect your health as smoke engulfs the city, Boutique SoHo office building facing foreclosure, Six indicted in scheme to send campaign dollars to Eric Adams, New York City loses billions as companies decamp for the South, Long-promised $7B Second Avenue subway expansion to break ground by year-end. Applicable Procedures Code: J1426. Pre Login - UHC Medicare These are plans that people can buy on their own, rather than through an employer or government program. Non-members may download and print search results from the online directory. Telehealth | UHCprovider.com Effective Date: 02.01.2023 This policy addresses closure (occlusion) of the left atrial appendage (LAA). Applicable Procedure Codes: 30117, 30120, 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465, 30468, 30469, 30560, 30999, 31237, L8699. Applicable Procedure Codes: 63185, 63190, 64405, 64553, 64555, 64568, 64570, 64575, 64590, 64633, 64634, 64722, 64744, 64771, 64999, K1023, L8679, L8680, L8685. Effective Date: 04.01.2023 This policy addresses the use of Radicava (edaravone) for the treatment of amyotrophic lateral sclerosis (ALS). Search Location Insurance Loading. Effective Date: 07.01.2023 This policy addresses the use of Tysabri (natalizumab) for the treatment of relapsing forms of multiple sclerosis and Crohn's disease. Can you send my medical records to the specialist? Benefits & Features Expand All Well and Sick Care Get the care you need to be at your best or to get better if you are injured or sick. Effective Date: 04.01.2023 This policy addresses nerve conduction studies and other neurophysiological testing. We serve more dual-eligible members in more states than any other health care company.1. Applicable Procedure Code: 27599. UnitedHealthcare Community Plan - Facebook Connect with a licensed medical provider 24/7 on your smartphone, tablet, or laptop/computer with CityMD virtual visits. Applicable Procedure Code: J0491. Applicable Procedure Codes: 0687T, 0688T, 0704T, 0705T, 0706T, 92065, 92066, 92499. Applicable Procedure Code: J0800. Effective Date: 03.01.2023 This policy addresses Ventricular Assist Devices. Find UnitedHealthcare Community Plan Plastic Surgeons & Providers with verified reviews. Sign up to get the latest news from CityMD. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950. Effective Date: 03.01.2023 This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Effective Date: 07.01.2023 This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Effective Date: 07.01.2023 This policy addresses outpatient occupational, physical, and speech therapy. Lab tests, x-rays and diagnostic imaging are covered. Effective Date: 03.01.2023 This policy addresses home sleep apnea testing, attended full-channel nocturnal polysomnography performed in a healthcare facility or laboratory setting, daytime sleep studies, and attended PAP titration. I never wait more than 5 minutes in the waiting room. Effective Date: 07.01.2023 This policy addresses the use of Evkeeza (evinacumab-dgnb) for the treatment of homozygous familial hypercholesterolemia (HoFH). Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999. Home Payment overview Insurance Paying with insurance We accept most major health insurance plans, including Managed Medicaid, Medicare Advantage, and exchange plans. CityMD typically charges a $225-$250 visit fee for patients without insurance. Effective Date: 07.01.2023 This policy addresses the use of interleukin-5 (IL-5) antagonists, including Cinqair (reslizumab), Fasenra (benralizumab), and Nucala (mepolizumab). Will I need to pre-register again? Our Aftercare team will guide you on the path back to health, by providing referrals and scheduling timely follow-up appointments for you after your visit. Applicable Procedure Code: J9332. Applicable Procedure Codes: 20552, 20553, 20605, 20606, 21010, 21050, 21060, 21070, 21085, 21089, 21110, 21240, 21242, 21243, 21247, 21299, 21499, 29800, 29804, 97039, 97139, E1399, E1700, E1701, E1702. Applicable Procedure Codes: J0739, J0741. Effective Date: 07.01.2023 This policy addresses the use of Hemgenix (etranacogene dezaparvovec-drlb) for the treatment of hemophilia B. Applicable Procedure Code: J1411. UnitedHealthcare Community Plan Medical Policy Update Bulletin: July 2023 General Information The inclusion of a health service (e.g., test, drug, device or procedure) in this bulletin indicates only that UnitedHealthcare is adopting a new policy and/or updated, revised, replaced or retired an existing policy; it does not imply that Effective Date: 06.01.2023 This policy addresses electrical stimulation for the treatment of pain and muscle rehabilitation, including transcutaneous electrical nerve stimulator (TENS), functional electrical stimulation (FES), and neuromuscular electrical stimulation (NMES). Effective Date: 07.01.2023 This policy addresses prostate surgeries and interventions, including transurethral ablation, cryoablation, surgical prostatectomy, prostatic urethral lift (PUL), high-energy water vapor thermotherapy, and transperineal placement of biodegradable material. Find a doctor, dentist or provider | UnitedHealthcare Applicable Procedure Codes: 62263, 62264, 62290, 62291, 62292, 64999, 72285, 72295. 4.4 star 35.8K reviews 1M+ Downloads Everyone info Install About this app arrow_forward Not all UHC plans are currently supported by the app, not all features are available for every plan. Yes if you havent already, add your dependent or share access with others in My Account > Caregiver Access. Effective Date: 07.01.2023 This policy addresses electrical stimulation and electromagnetic therapy for wounds. Therapy Services. In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities. Insurance | CityMD The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. Effective Date: 06.01.2023 This policy addresses genitourinary pathogen nucleic acid detection panel testing to evaluate symptomatic women for vaginitis. And, many have trained in the best hospitals, winning numerous awards for teaching and training fellow physicians. For Louisiana, click here. Effective Date: 07.01.2023 This policy addresses embolization of the ovarian or internal iliac veins. Applicable Procedure Codes: 0200T, 0201T, 0275T, 22586, 22630, 22899, 62287, 62380, G0276. Applicable Procedure Codes: 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 64490, 64491, 64492, 64493, 64494, 64495. Effective Date: 05.01.2023 This policy addresses bariatric surgical procedures, including gastric bypass, gastric banding, sleeve gastrectomy, biliopancreatic bypass, and biliopancreatic diversion with duodenal switch. Effective Date: 07.01.2023 This policy addresses genetic testing for cardiac disease. Applicable Procedure Code: J0490. Applicable Procedure Code: J3399. Effective Date: 07.01.2023 This policy addresses Reblozyl (luspatercept-aamt) for the treatment of anemia in adult patients with beta thalassemia and symptomatic anemia in patients with myelodysplastic syndromes or myelodysplastic/myeloproliferative neoplasms.
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