January 14, 2019
Area(s) of Interest: Commercial Payors Patient Care Practice Management Radiology
Citing the need for additional time for communication and optimal rollout, UnitedHealthcare (UHC) has delayed implementation of its outpatient advanced radiology policy until February 1, 2019.
The new UHC policy—originally scheduled for implementation on Jan. 1—requires prior authorization for advanced imaging procedures, including certain magnetic resonance imaging, magnetic resonance angiography and computed tomography imaging procedures, when performed in the outpatient hospital setting. Under UHC’s Outpatient Radiology Notification/Prior Authorization Protocol, a site of care review will be required for these advanced imaging services when performed in the outpatient hospital.
Site of care reviews will not be done as part of the prior authorization process if a procedure will be performed in a free-standing diagnostic radiology center or an office setting. Additionally, authorization will not be required for procedures performed in an emergency room, observation unit, urgent care center or during an inpatient stay.
The UHC policy is similar to a policy implemented by Anthem Blue Cross in December 2017.
For more information on the new policy, UHC has published the Site of Care for Outpatient MR/CT Services FAQ or physicians can visit the Radiology Prior Authorization and Notification page on the UHC website.
The California Medical Association will be closely monitoring this policy as it is implemented to better understand how it will affect physician practices and patient care.