AAP talks with UnitedHealthcare result in revised policies
RichardLander, M.D., FAAP
Private Payer Advocacy
The Academy’s ongoing dialogue with UnitedHealthcare (UHC) has resulted in positive
changes to its reimbursement policies impacting pediatricians.
Antitrust laws prohibit the AAP from negotiating payment and collective bargaining
for its members. However, the AAP advocates to payers on the importance of benefits
coverage for children and appropriate payments to pediatricians.
Below is a summary of changes to UHC reimbursement policies. The policies can be viewed
Codes 99173, 99174 and 99177 will be paid when they are reported with a preventive
medicine service code (e.g., 99393).
After hours/weekend care
Primary care providers will be paid for code 99051 when billed with acute care services
New patient visits
Effective Oct. 1, evaluation and management (E/M) services that do not meet the Centers
for Medicare & Medicaid Services’ (CMS) definition of a new patient will be denied.
The CMS definition is as follows: “An individual who did not receive any professional
services from the physician/non-physician practitioner (NPP) or another physician
of the same specialty who belongs to the same group practice within the previous 3
UHC also is reviewing its policies for consultation services and global days (E/M
services reported on the same day as a procedure code).
AAP members are encouraged to report concerns with payers by completing the online
Hassle Factor Form, http://bit.ly/2vsL7hd.
Dr. Lander is past chair of the AAP Payer Advocacy Advisory Committee.