September 01, 2022

New medical necessity criteria

Updated medical policy for hyperbaric oxygen therapy

Effective Dec. 1, 2022, we will only consider hyperbaric oxygen therapy (HBOT) services for CPT® codes 99183 or G0277 medically necessary for UnitedHealthcare commercial plan members with one of the listed diagnosis codes in the new hyperbaric oxygen therapy medical policy. 

Impacted plans
These changes affect UnitedHealthcare commercial plan members, including members of affiliate plans, such as UnitedHealthcare of the Mid-Atlantic, UnitedHealthcare Oxford, Neighborhood Health Partnership, and UnitedHealthcare of the River Valley.

Commercial plan members in the state of Rhode Island are excluded from this requirement.

Important points
Please note that:

  • We may deny HBOT claims for unproven diagnosis codes
  • These requirements apply to new and current HBOT users that do not have an appropriate diagnosis in their medical claims
  • This change won't affect any existing authorizations on file for HBOT, unless the member's eligibility changes

Contact Provider Services at 866-416-6594 if you have any questions.

CPT® is a registered trademark of the American Medical Association.
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