November 01, 2022
New medical necessity criteria for HBOT
Updated medical policy for Individual Exchange plans
Effective Jan. 1, 2023, we will only consider hyperbaric oxygen therapy (HBOT) services for CPT® codes 99183 or G0277 medically necessary for UnitedHealthcare Individual Exchange plan members with one of the listed diagnosis codes in the new hyperbaric oxygen therapy medical policy.
Providers will be required to submit an appropriate diagnosis code on the claim for services to be covered.
Impacted plans
These changes affect UnitedHealthcare Individual Exchange plans, also referred to as Individual and Family plans.
Important points
Please note that:
- We may deny HBOT claims for unproven diagnosis codes
- These requirements apply to new and current HBOT users that do not have an appropriate diagnosis in their medical claims
- This change won't affect any existing authorizations on file for HBOT, unless the member's eligibility changes
- This change will go into effect for UnitedHealthcare commercial plans on Dec. 1, 2022
Questions?
Contact Provider Services at 866-416-6594 if you have any questions.
