Effective November 1, 2021
United Healthcare will require you to request Prior Authorization for the following services for Interventional Pain Management. This is effective November 1, 2021.
Notice that mostly are for your Cervical & Thoracic regions. Notice that it is also required for your Genicular Nerve Block (but NOT for the Genicular Nerve RFA) and SI (but for the RFA).
Codes that require Prior Authorization from UHC:
United Healthcare Pain Management Injection Requiring Prior Authorization Effective November 1, 2021
CPT Code Description
62292 INJECTION PX CHEMONUCLEOLYSIS 1/MLT LUMBAR
64620 DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE
G0260 INJ PROC SI JNT;ANES STEROID&TX AGT&ARTHROGRPH
62320 NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN
62322 NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN
62324 NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN
62325 NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN
62326 NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN
62327 NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
62350 IMPLANT SPINAL CANAL CATHETER
62351 IMPLANT SPINAL CANAL CATHETER
62360 INSERT SPINE INFUSION DEVICE
62361 IMPLTJ/RPLCMT FS NON-PRGRBL PUMP
64451 INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG
64454 INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
64480 NJX AA&/STRD TFRML EPI CERVICAL/THORACIC EA ADDL
64484 NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL
64491 NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
64492 NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
64494 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
64495 NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
64520 INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC
64634 DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA
64636 DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL
64640 DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE
Read more about this update here: https://www.uhcprovider.com/content/dam/provider/docs/public/resources/network-bulletin/pain-inject-management-nb-appendix-auwww.uhcprovider.com/content/dam/provider/docs/public/resources/network-bulletin/pain-inject-management-nb-appendix-august-2021.pdfgust-2021.pdf
Today is October 8, 2021. Have you not noticed your claims are being rejected by your practice management clearinghouse as "Invalid ICD-10 Code"?
ICD-10 Pain Management Code M54.5 Deleted Effective October 1, 2021!
Yes?! Well, it is because the ICD-10 code M54.5 for Low Back Pain is now deleted effective all date of service from October 1, 2021!
So make sure you are aware of this and correct your claims by choosing the billable and appropriate ICD-10 code that will describe your deleted code M54.5.
Belo are some potential code replacements that you can use beginning October 1, 2021
New Codes you can potentially use:
Remember that when changes like this happens, this is not just for CMS Medicare claims but it applies to all commercial payers (at least the big insurance payers!).
Read more about this updates and change by clicking here https://www.cms.gov/medicare/icd-10/2022-icd-10-cm
ABOUT THE AUTHOR:
Ms. Pinky Maniri-Pescasio is the Founder of GoHealthcare Consulting. She is a National Speaker on Practice Reimbursement and a Physician Advocate. She has served the Medical Practice Industry for more than 25 years as a Professional Medical Practice Consultant.