October 30, 2018
Area(s) of Interest: Commercial Payors Interventional Radiology and Diagnostic Radiology
Effective January 1, 2019, UnitedHealthcare (UHC) will require prior authorization for certain advanced imaging procedures when performed in the outpatient hospital setting.
As highlighted in the UnitedHealthcare Network Bulletin October 2018, certain magnetic resonance imaging, magnetic resonance angiography and computed tomography imaging procedures will now be subject to a site of care review when performed in the outpatient hospital under UHC’s Outpatient Radiology Notification/Prior Authorization Protocol.
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 comes on the heels of a similar policy implemented by Anthem Blue Cross in December 2017.
The California Medical Association is in the process of evaluating the new UHC policy to better understand how it will affect physician practices and patient care. 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.