Starting June 1, 2021, we’re expanding our notification/prior authorization requirements and site of service medical necessity reviews to include certain procedures/CPT® codes for Dual Special Needs Plans (DSNPs) in New Jersey.
We’ll only require notification/prior authorization if these procedures/CPT codes will be performed in an outpatient hospital setting.
This change was previously announced in the December Network Bulletin for:
The revised Utilization Review Guidelines (URGs) can be accessed at UHCprovider.com > Policies and Protocols > Commercial Policies > Medical & Drug Policies and Coverage Determination Guidelines.
See our Frequently Asked Questions.