New prior authorization requirements for Individual Exchange plans

UnitedHealthcare Individual and Family Plan Reimbursement Policy Update Bulletin: December 2021

Policy Type Effective Date Summary of Changes
Telehealth and Telemedicine Policy, Professional January 1st, 2022
  • In alignment with the CMS Place of Service (POS) code set, beginning with dates of service on 01/01/2022, UnitedHealthcare Individual Exchange will consider for reimbursement the new Telehealth POS code 10 (Telehealth Provided in Patient’s Home). UnitedHealthcare Individual Exchange will continue to reimburse the existing POS code 02 (Telehealth Provided Other than in Patient’s Home).
  • CMS revised the description of POS code 02 and created a new POS code 10 as follows: POS 02: Telehealth Provided Other Than in Patient’s Home – The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology. POS 10: Telehealth Provided in Patient’s Home – The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology
Note: The absence of a policy does not automatically indicate or imply coverage. As always, coverage for a health service must be determined in accordance with the member’s benefit plan and any applicable federal or state regulatory requirements.

The complete library of UnitedHealthcare Individual & Family Plan Reimbursement Policies is available UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.