by Wyn Staheli, Director of Content - innoviHealth
Jun 8th, 2023
UnitedHealthcare has issued a notice that there is a new Manipulation Commercial Payer policy which will become effective on July 1, 2023. The previous one (effective April 1, 2023) stated the following in the “Coverage Rationale” portion of the policy:
The following notes the changes made in the new policy (highlighted is new, strikeout is removed):
There are a few things of particular to note in the changes. Personally, I am glad to see the removal of the text at the end because each of those bulleted items can be problematic for the healthcare provider. For example, who determines what is “pre-symptom state” or how would you know whether a patient has seen anyone else for the same condition? It’s also nice to see the removal of the limitation of 30 days; however, that doesn’t necessarily mean that they are going to begin covering an unlimited number of visits.
It’s a little interesting that they created a new bullet titled “Musculoskeletal Disorders”. Even though above this noncoverage section, they do say (emphasis added) “Manipulative therapy is proven and medically necessary for treating Musculoskeletal Disorders, except as noted below,” the new grouping just makes it a little harder to follow from my viewpoint.
Another interesting change is in the “Definitions” section as follows (highlighted information is new):
Whenever one payer releases a new policy, it’s not uncommon for other payers to also review their policies so watch for announcements from other payers.
About Wyn Staheli, Director of Content - innoviHealth
Wyn Staheli is the Director of Content Research for innovHealth. She has over 30 years of experience in the healthcare industry. With her degree in Management Information Systems (MIS), she has been a programmer for a large insurance carrier as well as a California hospital system. She is also the author and editor of many medical resource books and the founder of InstaCode Institute.