Applicable Procedure Codes: 38205, 38206, 38207, 88240, S2140. This is not a complete list. For Kentucky, click here. Effective Date: 12.01.2022 This policy addresses breast reconstruction post-mastectomy and for the treatment of Poland syndrome, removal of breast implants, and breast repair and reconstruction not post mastectomy. Applicable Procedure Codes: J1950, J1951, J1952, J3315, J3316, J9155, J9202, J9217, J9225, J9226. Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. Effective Date: 07.01.2023 This policy addresses upper extremity myoelectric prosthetic devices. Applicable Procedure Codes: 0650T, 33285, 33286, 93224, 93225, 93226, 93227, 93228, 93229, 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248, 93268, 93270, 93271, 93272, 93285, 93291, 93298, E0616, G2066. Our doctors regularly provide complete physical exams (routine, for work, sports or school), including blood work. People who need help to live independently. Effective Date: 03.01.2023 This policy addresses review of certain new to market medications that are healthcare provider administered. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs. Alternatively, you can also search locations by selecting your state and city from our drop downs below. We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. Effective Date: 03.01.2023 This policy addresses Ventricular Assist Devices. Effective Date: 03.01.2023 This policy addresses the use of Leqvio (inclisiran) for the treatment of heterozygous familial hypercholesterolemia (HeFH) and clinical atherosclerotic cardiovascular disease (ASCVD). The 5 Star rating applies to plan year 2023. 8:00 am to 6:00 pm Eastern Time, Monday Friday. Effective Date: 03.01.2023 This policy addresses virtual upper gastrointestinal endoscopy. Preventive checkups, shots and lab tests. All appointment times are guaranteed by our UnitedHealthcare Community Plan Plastic Surgeons & Providers. Browse our full list to see if youre covered. Effective Date: 07.01.2023 This policy addresses minimally invasive spine surgery procedures. For Louisiana, click here. Dr. dependents or parents)? Applicable Procedure Codes: J0585, J0586, J0587, J0588. Effective Date: 03.01.2023 This policy addresses lysis intranasal synechia, repair of nasal vestibular stenosis or alar collapse, rhinoplasty, rhinophyma, septal dermatoplasty, nasal polypectomy, nasal septal swell body reduction, and nasal implants. See our services. Applicable Procedure Code: 19318. Applicable Procedure Code: J2507. Effective Date: 07.01.2023 This policy addresses the use of denosumab (Prolia & Xgeva). Applicable Procedure Code: 94799. Applicable Procedure Codes: 0278T, 0720T, 63650, 63655, 63663, 63664, 63685, 64555, 64999, A4556, A4557, A4558, A4595, A4630, E0720, E0730, E0731, E0744, E0745, E0762, E0764, E0770, E1399, K1023, L8679, L8680, L8682, L8685, L8686, L8687, L8678, L8688, S8130, S8131. Applicable Procedure Code: J0584. Effective Date: 11.01.2022 This policy addresses intrauterine fetal surgery. Effective Date: 11.01.2022 This policy addresses surgery of the foot. Community Plan Reimbursement Policies For policies listed below that do not apply to UnitedHealthcare Community Plan Medicare products, as indicated in the Application section of each policy, please refer to the UnitedHealthcare Medicare Advantage Reimbursement Policies for further information. Yes, if you have a photo ID and your Member ID number, or can get it from your insurance provider. Applicable Procedure Code: 42699. Absolutely! Effective Date: 03.01.2023 This policy addresses spinal fusion and bone healing enhancement products. Applicable Procedure Code: 0184T. Find links for UnitedHealthcare's secure sites for members, employers, brokers or providers. Stay connected to New York business news in print and online. Effective Date: 06.01.2023 This policy addresses pneumatic compression devices. No, you cannot make changes to your registration at this time. Applicable Procedure Code: 82523. Applicable Procedure Codes: J1745, Q5103, Q5104, Q5109, Q5121. Applicable Procedure Codes: S9123, S9124, T1000, T1001, T1002, T1003, T1030, T1031. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 0646T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33370, 33418, 33419, 33477, 33999, 93799. Applicable Procedure Codes: A4600, E0650, E0651, E0652, E0655, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673, E0675, E0676. Search Location Insurance Loading. Applicable Procedures Codes: J0185, J1453, J1454, J1626, J1627, J2405, J2469, J8501, J8655, J8670, Q0162, Q0166. I missed my CityMD visit, but I still need to come in. Plans that are low cost or no-cost, Medicare dual eligible special needs plans Effective Date: 07.01.2023 This policy addresses durable medical equipment (DME), orthotics, medical supplies, and repairs/replacements. Effective Date: 05.01.2023 This policy addresses the use of Vyondys 53 (golodirsen) for the treatment of Duchenne muscular dystrophy (DMD). Effective Date: 04.01.2023 This policy addresses the use of Parsabiv (etelcalcetide) for the treatment of secondary hyperparathyroidism with chronic kidney disease. Applicable Procedure Codes: 86704, 86705, 86706, 86707, 86708, 86709, 86803, 86804, 87340, 87341, 87350, 87902, 87912, G0472, G0499. You are responsible for submission of accurate claims requests. We recommend that you call the member's services number on the back of your insurance card to ask about coverage and co-payment fees for urgent care visits. Effective Date: 04.01.2023 This policy addresses the use of Ketalar (ketamine) for anesthesia purposes and Spravato (esketamine) for the treatment of treatment-resistant depression (TRD) and major depressive disorder (MDD). Applicable Procedure Codes: J0517, J2182, J2786. Effective Date: 01.01.2023 This policy addresses cognitive rehabilitation and coma stimulation. Applicable Procedure Codes: 0254U, 0396U, 58970, 58974, 76948, 81228, 81229, 81349, 81479, 89250, 890251, 89253, 89254, 89255, 89258, 89260, 89261, 89264, 89268, 89272, 89280, 89281, 89290, 89291, 89342, 89257, 89352, S4011, S4015, S4016, S4022, S4037. PDF (Portable Document Format) files can be viewed with Adobe Reader. Do you or someone you know have Medicaid and Medicare? For policies listed below that do not apply to UnitedHealthcare Community Plan Medicare products, as indicated in the Application section of each policy, please refer to the UnitedHealthcare Medicare Advantage Reimbursement Policies for further information. Why should I pre-register for a CityMD visit before I arrive at the urgent care center. Individuals can also report potential inaccuracies via phone. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services. Effective Date: 06.01.2023 This policy addresses sacral nerve stimulation for urinary and fecal indications. Effective Date: 06.01.2023 This policy addresses durable medical equipment (DME), orthotics, medical supplies, and repairs/replacements. They represent a portion of the resources used to support UnitedHealthcare coverage decision making. Effective Date: 04.01.2023 This policy addresses functional endoscopic sinus surgery (FESS). Applicable Procedure Code: J0897. Effective Date: 01.01.2023 This policy addresses collection and storage of umbilical cord blood. Applicable Procedure Codes: 0656T, 0657T, 22899. UnitedHealthcare Connected for One Care (Medicare-Medicaid Plan) is a health plan that contracts withboth Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. Resource Center Applicable Procedure Codes: 59074, 59076, 59897, S2400, S2401, S2402, S2403, S2404, S2405, S2409, S2411. Applicable Procedure Codes: 29868, G0428. Effective Date: 07.01.2023 This policy addresses intraosseous radiofrequency ablation, ablation for treating sacroiliac pain, and other facet joint nerve ablation procedures for spinal pain. In an emergency, call 911 or go to the nearest emergency room. Applicable Procedure Codes: E1399, E1800, E1801, E1802, E1805, E1806, E1810, E1811, E1812, E1815, E1816, E1818, E1825, E1830, E1831, E1840, E1841. The New York State Medicaid Managed Care Plan is offered through UnitedHealthcare Community Plan. Effective Date: 07.01.2023 This policy addresses arterial compliance testing using waveform analysis, carotid intima-media thickness (CIMT) measurement, advanced lipoprotein analysis, endothelial function assessment, and tests for lipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme, other human A2 phospholipases, and long-chain omega-3 fatty acids. Effective Date: 11.01.2022 This policy addresses the use of Xolair (omalizumab) for subcutaneous use for the treatment of moderate to severe persistent asthma, chronic urticaria, and nasal polyps. Get started by finding your plan on our list. This Community Plan medical policy library does not apply to the following states; click the link to view the applicable Medical & Drug Policies and Coverage Determination Guidelines: ForLouisiana, clickhereto view MCG criteria for the top Outpatient procedures and Admission diagnoses. You'll need a valid photo ID and insurance card (if you're paying with insurance). Effective Date: 12.01.2022 This policy addresses home sleep apnea testing, attended full-channel nocturnal polysomnography performed in a healthcare facility or laboratory setting, daytime sleep studies, and attended PAP titration. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability. Effective Date: 07.01.2023 This policy addresses Reblozyl (luspatercept-aamt) for the treatment of anemia in adult patients with beta thalassemia and symptomatic anemia in patients with myelodysplastic syndromes or myelodysplastic/myeloproliferative neoplasms. The information provided through this service is for informational purposes only. While your primary doctor cares for multiple chronic medical issues, we treat the problems facing you today. Enrollment in the plan depends on the plans contract renewal with Medicare. Yes. UnitedHealthcare Connected (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees. Get Care Now What we treat. Effective Date: 03.01.2023 - This policy addresses virtual upper gastrointestinal endoscopy. They are also used to decide whether a given health service is medically necessary. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Medical Policies, Medical Benefit Drug Policies, Coverage Determination Guidelines, and Utilization Review Guidelines are developed as needed, are regularly reviewed and updated, and are subject to change. This reimbursement policy applies to all professionals who deliver health care services. Applicable Procedure Code: J0567. Effective Date: 12.01.2022 This policy addresses autologous cellular therapy. Applicable Procedure Codes: 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889. Effective Date: 10.01.2022 This policy addresses DNA-based noninvasive prenatal tests. Applicable Procedures Code: J1426. Effective Date: 01.01.2023 This policy addresses breast ductal lavage, breast ductal fluid aspiration and cytology, and fiberoptic ductoscopy with or without ductal lavage. Effective Date: 07.01.2023 This policy addresses the use of Stelara (ustekinumab) for the treatment of Crohns disease, plaque psoriasis, psoriatic arthritis, and ulcerative colitis. Effective Date: 11.01.2022 This policy addresses the use of Krystexxa (pegloticase) for treatment of chronic gout refractory to conventional therapy. Find a CityMD near you: Virtual care Now you can get quality medical carein the comfort of your own home. Applicable Procedure Codes: 43647, 43648, 43881, 43882, 64590, 64595, 72195, 72196, 72197, 76496, 91117, 91120, 91122, 91132, 91133. Applicable Procedure Codes: 15877, 15878, 15879. Effective Date: 12.01.2022 This policy addresses neuropsychological testing and computerized cognitive testing under the medical benefit. Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017. Effective Date: 10.01.2022 This policy addresses the use of Ilaris (canakinumab) for the treatment of cryopyrin-associated periodic syndromes (CAPS), tumor necrosis factor (TNF) receptor-associated periodic syndrome (TRAPS), hyperimmunoglobulin D (Hyper-IgD) syndrome (HIDS)/mevalonate kinase deficiency (MKD), familial mediterranean fever (FMF), Stills disease, and systemic juvenile idiopathic arthritis (SJIA). Effective Date: 01.01.2023 This policy addresses the use of Oxlumo (lumasiran) for the treatment of primary hyperoxaluria type 1 (PH1). To pre-register for someone else, select the care recipient in the top right corner of the screen to enter their account, and then Plan your CityMD visit. Applicable Procedure Codes: 0422T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T, 76376, 76377, 76391, 76498, 76499, 76641, 76642, 77046, 77047, 77048, 77049, 77065, 77066, 77067, S8080. Some network providers may have been added or removed from our network after this directory was updated. Effective Date: 03.01.2023 This policy addresses the SynCardia temporary Total Artificial Heart. Applicable Procedure Codes: 22853, 22854, 22859, 22867, 22868, 22869, 22870, 22899, C1821. Effective Date: 02.01.2023 This policy addresses facet joint injections/medial branch blocks for spinal pain. Our Medical Policies and Medical Benefit Drug Policies express our determination of whether a health service (e.g., test, device or procedure) is proven to be effective based on the published clinical evidence. Effective Date: 03.01.2023 This policy addresses autologous (sural) and allogenic nerve grafts to restore erectile function during or after radical prostatectomy. Information to clarify health plan choices for people with Medicaid and Medicare. Applicable Procedure Codes: 20605, 20606, 20610, 20611, J3490, J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, J7331, J7332. Network providers help you and your covered family members get the care needed. For California members, note that the materials provided to you are guidelines used by this plan to authorize, modify, or deny care for persons with similar illnesses or conditions. Here are some resources for people with Medicaid and Medicare. Applicable Procedure Codes: 63650, 63655, 63685, 63688, C1767, C1778, C1816, C1820, C1822, C1823, C1883, C1897, L8679, L8680, L8682, L8685, L8686, L8687, L8688, L8695. Yes if you havent already, add your dependent or share access with others in My Account > Caregiver Access. Applicable Procedure Codes: 27299, 49659, 49999. Applicable Procedure Code: 27599. Effective Date: 07.01.2023 This policy addresses the use of Tzield (teplizumab-mzwv) to delay the onset of stage 3 type 1 diabetes. Applicable Procedure Code: J3111. Eligibility Applicable Procedure Codes: J2998, J3490, J3590. Behavioral health programs may help you cope with emotional struggles. Look here atMedicaid.gov. Applicable Procedure Codes: 43210, 43257, 43284, 43289, 43497, 43499, 43999. Get the most out of your coverage. Hands down this was the best urgent care center I've ever been to. Effective Date: 04.01.2023 This policy addresses the use of Tepezza (teprotumumab-trbw) for the treatment of thyroid eye disease. Effective Date: 07.01.2023 This policy addresses multiple services/procedures. Effective Date: 07.01.2023 This policy addresses the intravenous use of Skyrizi (risankizumab-rzaa) for the treatment of Crohns disease. Make an appointment online instantly with Urgent care that accept UnitedHealthcare Community Plan insurance. Effective Date: 07.01.2023 This policy addresses transanal endoscopic microsurgery for the excision of small tumors localized to the rectum. Effective Date: 07.01.2023 This policy addresses spinal fusion and decompression procedures, laminectomy, isolated facet fusion, dynamic stabilization systems, and total facet joint arthroplasty. Find a Provider Find a pharmacy Find a local pharmacy that's convenient for you. Valuable information and tips to help those who care for people with both Medicaid and Medicare, Medicaid We serve more dual-eligible members in more states than any other health care company.1. Effective Date: 05.01.2023 This policy addresses the medical necessity of certain planned surgical procedures when performed in a hospital outpatient department. UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Applicable Procedure Code: J1428. Effective Date: 11.01.2022 This policy addresses the use of Nplate (romiplostim) for the treatment of chronic immune thrombocytopenic purpura (ITP). Applicable Procedure Codes: C9096, J1442, J1447, J2506, J2820, Q5101, Q5108, Q5110, Q5111, Q5120, Q5122, Q5127, Q5130. The information provided through this service is for informational purposes only. 28 reviews Unclaimed Health Insurance Offices Closed 8:00 AM - 8:00 PM See hours Write a review Add photo Save Photos & videos See all 2 photos Add photo Other Health Insurance Offices Nearby Sponsored MetroPlusHealth 4.5 miles away from this business Effective Date: 03.01.2023 This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Sign up to get the latest news from CityMD. Your health information is kept confidential in accordance with the law. Here are some resources for people with Medicaid and Medicare. I received a letter about changes to my Medicaid insurance coverage. UnitedHealthcare offers UnitedHealthcare Community Plan plans for New York and eligible counties. Applicable Procedure Codes: 0424T, 0425T, 0426T, 0427T, 0428T, 0429T, 0430T, 0431T, 0432T, 0433T, 0434T, 0435T, 0436T, 21142, 21199, 21206, 21685, 41512, 41530, 41599, 42145, 42299, 64553, 64568, 64569, 64570, 64582, 64583, 64584, A7049, E0485, E0486, E1399, K1001, K1027, K1028, K1029, L8679, L8680, L8686, S2080, S2900. Effective Date: 03.01.2023 This policy addresses home sleep apnea testing, attended full-channel nocturnal polysomnography performed in a healthcare facility or laboratory setting, daytime sleep studies, and attended PAP titration. Most have their certifications in emergency medicine or family medicine. UnitedHealthcare Connected for One Care (Medicare-Medicaid Plan) Effective Date: 05.01.2023 This policy addresses the use of Exondys 51 (eteplirsen) for the treatment of Duchenne muscular dystrophy (DMD). The service is not an insurance program and may be discontinued at any time. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950. Join Our Network expand_more Provider Directories, Referral Listings and Home and Community Based Services Providers expand_more Member Information: Current Medical Plans, ID Cards, Provider Directories, Dental & Vision Plans expand_more Maryland Specialty Referral Requirements expand_more Medicaid Managed Care Rule expand_more This plan is available to anyone who has both Medical Assistance from the State and Medicare. For more information to help you better understand when to go to an ER or Urgent Care Center, please see our Know Where to Go Guide. May I pre-register for others besides myself (ie. Can you send my medical records to the specialist? Applicable Procedure Code: J2356. Applicable Procedure Codes: B4100, B4102, B4103, B4104, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, B9002, S9432, S9433, S9434, S9435. Effective Date: 03.01.2023 This policy addresses electroencephalographic (EEG) monitoring and video recording. Effective Date: 03.01.2023 This policy addresses warming therapy, noncontact normothermic wound therapy, and low frequency ultrasound for treating wounds. Effective Date: 07.01.2023 This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Effective Date: 08.01.2022 This policy addresses emergency ambulance (ground, water, or air) and non-emergency ambulance (ground or air) services. Effective Date: 02.01.2023 This policy addresses functional endoscopic sinus surgery (FESS). Effective Date: 07.01.2023 This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Applicable Procedure Codes: 62320, 62321, 62322, 62323, 64479, 64480, 64483, 64484. Effective Date: 05.01.2022 This policy addresses private duty nursing (PDN) services. Effective Date: 07.01.2023 This policy addresses the use of Tezspire (tezepelumab) for the treatment of severe asthma. Effective Date: 01.01.2023 This policy addresses clinical trials. Effective Date: 07.01.2023 This policy addresses the use of Orencia (abatacept) injection for intravenous infusion for the treatment of polyarticular juvenile idiopathic arthritis, rheumatoid arthritis, psoriatic arthritis, chronic graft-versus-host disease, and immune checkpoint inhibitor-related toxicities. You can give us a copy of your insurance card later. Dr. Sophia Myers, DC, FASA is a Chiropractor & Acupuncturist practicing in Raleigh since 1998. Utilization Review Guidelines apply clinical practice guidelines to determine whether the health care services provided or planned for an individual member are the most appropriate and cost-effective services under the specific circumstances. It's for New York State residents who meet the income or disability requirements. Applicable Procedure Codes: 0237U, 0401U, 81410, 81411, 81413, 81414, 81439, 81479, 81493. Need access to the UnitedHealthcare Provider Portal? Effective Date: 07.01.2023 This policy addresses the use of Lemtrada (alemtuzumab) for treatment of relapsing forms of multiple sclerosis. Applicable Procedure Codes: J1437, J1439, Q0138. Effective Date: 05.01.2023 This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Applicable Procedures Code: J0224. Copyright 2010 - 2023 Summit Health Management, LLC. Applicable Procedure Codes: 86704, 86705, 86706, 86707, 86708, 86709, 86803, 86804, 87340, 87341, 87350, 87467, 87902, 87912, G0472, G0499. Applicable Procedure Codes: J0178, J0179, J2503, J2777, J2778, J2779, J9035, Q5124, Q5128. People living with disabilities or other serious health conditions. Effective Date: 03.01.2023 This policy addresses the use of Onpattro (patisiran) and Amvuttra (vutrisiran) for the treatment of polyneuropathy of hereditary transthyretin-mediated (hATTR) amyloidosis. Although our offices are staffed by board certified emergency medicine physicians, life threatening emergencies may require hospitalization and the advanced care available only at a hospital. About us Quality care starts here We know we're often your first stop to getting well, and we take that responsibility seriously. Effective Date: 03.01.2023 This policy addresses clinical trials. Effective Date: 06.01.2023 This policy addresses genitourinary pathogen nucleic acid detection panel testing to evaluate symptomatic women for vaginitis. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. Current Policies & Guidelines This Community Plan medical policy library does not apply to the following states; click the link to view the applicable Medical & Drug Policies and Coverage Determination Guidelines: For Indiana, click here. Effective Date: 04.01.2023 This policy addresses vertebral body tethering for the treatment of scoliosis. Sign up to get the latest news from CityMD. Effective Date: 04.01.2023 This policy addresses core decompression for avascular necrosis. Effective Date: 01.01.2023 This policy addresses lysis intranasal synechia, repair of nasal vestibular stenosis or alar collapse, rhinoplasty, rhinophyma, nasal polypectomy, nasal septal swell body reduction and nasal implants. Effective Date: 04.01.2023 This policy addresses the use of white blood cell colony stimulating factors (CSFs), including the drug products Fulphila, Granix, Leukine, Neulasta, Neupogen, Nivestym, Nyvepria, Releuko, Udenyca, Zarxio, and Ziextenzo. Find a Pharmacy Find a dentist Applicable Procedure Codes: 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 64490, 64491, 64492, 64493, 64494, 64495.
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