January 2022 policy and protocol updates overview

Your notice of protocol and policy changes from UnitedHealthcare

Appendix Bulletins

Medical policy updates: January 2022
This month, you’ll find updates for Medicaid, Medicare Advantage, Exchange and commercial plans.

Reimbursement policy updates: January 2022
This month, you’ll find updates for commercial plans.

Specialty Medical Injectable Drug program updates: January 2022
See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members.


Prior Authorization

West region: Prior authorization and clinical letters are going paperless
Beginning April 1, 2022, we will no longer mail prior authorization and clinical decision letters, for most* UnitedHealthcare plans in the West region.

New York: Prior authorization updates will not be required for palonosetron
We previously announced that prior authorization would soon be required for the anti-emetic drug palonosetron HCI, 25 mg (HCPCS code J2469), when prescribed to UnitedHealthcare Community Plan members in New York.

Prior authorization updates for radiation and chemotherapy
Starting April 1, 2022, radiation therapy and chemotherapy services will require prior authorization for Individual Exchange plans in Arizona, Alabama, Florida, Georgia, Illinois, Louisiana, Maryland, Michigan, North Carolina, Oklahoma, Tennessee, Texas, Virginia, and Washington.

Cardiovascular prior authorization claims notice
Effective April 1, 2022, we will implement a new claim review process for outpatient facility claims with cardiovascular codes that require prior authorization for Medicare Advantage members.

Medicaid: New prior authorization codes in select states
Effective April 1, 2022, we are adding new codes to the prior authorization list for cardiovascular procedures, prostate procedures, spine surgery and cosmetic surgery.


Other policy and protocol updates

Vitamin D screening policy updates for commercial members
Starting March 1, 2022, we will only cover Vitamin D screening CPT® codes 82306, 82652 or 0038U for UnitedHealthcare commercial members diagnosed with one of the listed diagnosis codes in the coverage determination guideline.

Indiana: New outpatient injectable drug requirements
Effective April 1, 2022, we will require prior authorization for the medications listed in the table below for UnitedHealthcare Community Plan of Indiana members.

2022 Administrative guide now available
Effective Jan. 1, 2022, the updated UnitedHealthcare Care Provider Administrative Guide will be available at UHCprovider.com/guides

PCA-21-04509-MarComm-WEB_122021