![]() References to CPT ® or other sources are for definitional purposes only and do not imply any right to reimbursement or guarantee claims payment. UnitedHealthcare Medicare Advantage Policy Guidelines use Current Procedural Terminology (CPT ®**), CMS, or other coding guidelines. Medicare Advantage Policy Guidelines are intended to ensure that coverage decisions are made accurately based on the code or codes that correctly describe the health care services provided. You are responsible for submission of accurate claims. Unauthorized copying, use and distribution of this information are strictly prohibited. Medicare Advantage Policy Guidelines are the property of UnitedHealthcare. The information presented in the Medicare Advantage Policy Guidelines is believed to be accurate and current as of the date of publication, and is provided on an "AS IS" basis. UnitedHealthcare may modify these Policy Guidelines at any time by publishing a new version of the policy on this website. They represent a portion of the resources used to support UnitedHealthcare coverage decision making. ![]() Medicare Advantage Policy Guidelines are developed as needed, are regularly reviewed and updated, and are subject to change. Medicare Advantage Policy Guidelines may not be implemented exactly the same way on the different electronic claims processing systems used by UnitedHealthcare due to programming or other constraints however, UnitedHealthcare strives to minimize these variations. View a list of services that are subject to notification/prior authorization requirements. UnitedHealthcare's Medicare Advantage Policy Guidelines do not include notations regarding prior authorization requirements. Physicians and other healthcare professionals can sign up for regular distributions for policy or regulatory changes directly from CMS and/or your local carrier. UnitedHealthcare encourages physicians and other healthcare professionals to keep current with any CMS policy changes and/or billing requirements by referring to the CMS or your local carrier website regularly. UnitedHealthcare follows Medicare coverage guidelines and regularly updates its Medicare Advantage Policy Guidelines to comply with changes in Centers for Medicare & Medicaid Services (CMS) policy. In the event of a conflict, the member specific benefit plan document supersedes the Medicare Advantage Policy Guidelines. The member specific benefit plan document identifies which services are covered, which are excluded, and which are subject to limitations. Members should always consult their physician before making any decisions about medical care.īenefit coverage for health services is determined by the member specific benefit plan document* and applicable laws that may require coverage for a specific service. ![]() Treating physicians and healthcare providers are solely responsible for determining what care to provide to their patients. These Policy Guidelines are provided for informational purposes, and do not constitute medical advice. UnitedHealthcare has developed Medicare Advantage Policy Guidelines to assist us in administering health benefits. The Medicare Advantage Policy Guidelines are applicable to UnitedHealthcare Medicare Advantage Plans offered by UnitedHealthcare and its affiliates. Learn how to get a fast appeal for Medicare-covered services you get that are about to stop.Please read the terms and conditions below carefully Authorization to Disclose Personal Health Information (PDF) Learn how to get a fast appeal for Medicare-covered services you get that are about to stop. How to appeal a coverage or payment decision made by Medicare, your health plan, drug plan or Medicare Medical Savings Account (MSA) Plan. Check the status of a claimĬheck your claim status with your secure Medicare account, your Medicare Summary Notice (MSN), your Explanation of Benefits (EOB), Medicare's Blue Button, or contact your plan. You should only need to file a claim in very rare cases. Get information on how and when to file a claim for your Medicare bills (sometimes called "Medicare billing"). Contact your State Health Insurance Assistance Program (SHIP) for local, personalized Medicare counseling. Find out how to file a complaint (also called a "grievance") if you have a concern about the quality of care or other services you get from a Medicare provider.
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