Starting Feb. 1, 2022, we’ll require prior authorization for the complementary benefit of private duty nursing (HCPCS code T1000) offered only to designated Medicare Advantage® retiree plans through UnitedHealthcare Retiree Solutions. To determine member eligibility, go to UHCprovider.com.
You can request prior authorization:
We’ll contact the requesting health care professional and member with our coverage decision within 15 calendar days, or sooner based on applicable regulations. If we deny coverage, we’ll include appeal information in the denial letter.
If you don’t complete a prior authorization before providing services, we’ll deny the claim, and you won’t be able to bill the member for the services.
The UnitedHealthcare Medicare Advantage® Coverage Summary provides guidance and links to the InterQual® medical necessity criteria.