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  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
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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 M54.5 DELETED EFFECTIVE OCTOBER 1, 2021 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
 Insurance Prior Authorization Services, Patients Access and Medical Documentation Reviews and Audits. New Codes you can potentially use:  Low Back Pain ICD-10 M54.5 DELETED EFFECTIVE OCTOBER 1, 2021 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, MSC, CSPPM, CRCR, CSBI, CSPR, CSAF 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. Current HFMA Professional Expertise Credentials: HFMA Certified Specialist in Physician Practice Management (CSPPM) HFMA Certified Specialist in Revenue Cycle Management (CRCR) HFMA Certified Specialist Payment & Reimbursement (CSPR) HFMA Certified Specialist in Business Intelligence (CSBI) 
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