New York Payment Policy Change

Effective Dec. 1, 2020,  CPT© codes contained in the New York Non-Covered Code Payment Policy will be revised in accordance with the New York State Department of Health Reimbursement Guidelines.

  • UnitedHealthcare Community Plan for Families (Medicaid)
  • UnitedHealthcare Community Plan Wellness 4 Me (HARP)
  • UnitedHealthcare Community Plan Essential Plan (EP) Products. 

This update will affect CPT Codes for physical and occupational therapy and for evaluation management. All other CPT codes for physical and occupational therapy services will be considered non-covered.

The non-covered code list section clarifies and supplements the UnitedHealthcare Community Plan of New York National Outpatient Physical and Occupational Therapy policy. All other CPT codes for physical and occupational therapy services will be considered non-covered.

Check the member benefit plan document that may supersede the additional considerations and coverage limitations and exclusions and prior authorization requirements.

UnitedHealthcare’s reimbursement policies can be found online at uhcprovider.com > Community Plan Policies > Reimbursement Policies for Community Plan > Non Covered and Covered Codes Policy, Professional-Reimbursement Policy – UnitedHealthcare Community Plan

Questions? Please call your Network Representative directly or call Provider Services for UnitedHealthcare Community Plan at 888-362-3368. 

CPT® is a registered trademark of the American Medical Association