The UnitedHealthcare Community Plan has published an update in the September 2020 Network Bulletin that may affect your practice's bottom line. This update is effective December 1, 2020.
UnitedHealthcare has updated their list of payable codes for Outpatient Physical and Occupational Services provided in New York.
Below is a table of the payable codes. All other PT and OT codes are now non-payable for the UnitedHealthcare Community Plan.
CPT Code | Description of Payable Code |
|---|---|
97161 | Physical Therapy Evaluation - Low Complexity |
97162 | Physical Therapy Evaluation - Moderate Complexity |
97163 | Physical Therapy Evaluation - High Complexity |
97164 | Physical Therapy Re-Evaluation |
97165 | Occupational Therapy Evaluation - Low Complexity |
97166 | Occupational Therapy Evaluation - Moderate Complexity |
97167 | Occupational Therapy Evaluation - High Complexity |
97168 | Occupational Therapy Re-Evaluation |
97530 | Therapeutic Activities |
97542 | Wheelchair Management |
Below is a table of the Non-Covered PT and OT codes that the UnitedHealthcare Community Plan will no longer pay.
CPT Code | Description of Payable Code |
|---|---|
97012 | Traction - Mechanical |
97014 | Electrical Stimulation |
97016 | Vasopneumatic Devices |
97018 | Paraffin Bath |
97022 | Whirlpool |
97024 | Diathermy |
97026 | Infrared |
97028 | Ultraviolet |
97032 | Electrical Stimulation (Manual) |
97033 | Iontophoresis |
97034 | Contrast Baths |
97035 | Ultrasound |
97036 | Hubbard Tank |
97039 | Unlisted Modality |
97110 | Therapeutic Procedure - Exercise |
97112 | Therapeutic Procedure - Neuromuscular |
97113 | Therapeutic Procedure - Aquatic Therapy |
97116 | Therapeutic Procedure - Gait Training |
97139 | Unlisted Therapeutic Procedure |
97140 | Manual Therapy Techniques |
97150 | Therapeutic Procedure(s) - 2 or more individuals |
97533 | Sensory Integrative Techniques |
97535 | Self-Care/Home Management Training |
97537 | Community/Work Reintegration Training |
97750 | Physical Performance Test or Measurement |
97755 | Assistive Technology Assessment |
97760 | Orthotics Management and Training |
97761 | Prosthetic(s) Training |
97763 | Orthotics/Prosthetics Management and Training |
97799 | Unlisted Physical Medicine/Rehabilitation Service or Procedure |