CMS and UnitedHealthcare require a JG modifier on Medicare claims for separately payable, OPPS 340B drugs and biologics (status indicator K) to receive claims payment of ASP minus 22.5%.

For claims processed on or after March 1, 2022, vitamin D screening CPT codes 82306, 82652 or 0038U will only be covered for UnitedHealthcare commercial members diagnosed with one of the listed diagnosis codes in the medical policy.

Commercial plan Prescription Drug List and Pharmacy Benefit Coverage Updates that will take effect May 1, 2021 are now available to view.

Beginning April 1, 2022, the entire claim will be denied if outpatient cardiovascular prior authorizations are not received or denied due to lack of medical necessity for Medicare Advantage plans.

UnitedHealthcare has created the Designated Diagnostic Provider Imaging – a tiered benefit design – to help members receive higher-quality, more affordable imaging services.