Revised UnitedHealthcare E&M, Prior Auth Procedures to Take Effect Jan. 1
By Ellen Terry


The Texas Medical Association’s reimbursement specialists want to be sure you see these items in the UnitedHealthcare (UHC) December bulletin

Evaluation and management (E&M) coding: Starting Jan. 1, UHC will follow the revised 2021 E&M coding and guideline changes from the American Medical Association and Centers for Medicare & Medicaid Services. UHC recommends you use the educational modules and other resources on AMA’s Implementing CPT® Evaluation and Management (E/M) revisions webpage to help understand the new guidelines. TMA also has recorded two webinars on the E&M changes, free for TMA members. 

Prior authorization: Starting Jan. 1 for its Medicare Advantage plans, UHC will expand prior authorization requirements and site-of-service medical necessity reviews to include certain procedures/codes. Although UHC published an updated code list in September, the payer has since removed 11 colonoscopy and biopsy codes and nine repair-of-the-retina codes from the list, for dates of service on or after June 1, 2021. Preview the Jan. 1 Outpatient Surgical Procedures – Site of Service guideline. 

Laboratory test registry: UHC has again delayed implementation of its Laboratory Test Registry protocol, until Jan. 1, 2022, due to the ongoing national public health emergency. Under the protocol, which will apply to most commercial, Medicare Advantage, and community plan networks, claims for most lab test services must contain your lab’s unique test code for each service, and the test code must match a corresponding lab test registration provided to UHC by Dec. 1, 2021.

Last Updated On

December 09, 2020

Originally Published On

December 09, 2020

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Ellen Terry

Project Manager, Client Services

(512) 370-1391

Ellen Terry has been writing, editing, and managing communication projects at TMA since 2000. She hails from Victoria, Texas; has a journalism degree from Texas State University; and loves to read great fiction. Ellen and her husband have two grown sons and a couple of cats.

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