MAC and National Organizations Continue Effort to End This Unjustified Administrative Burden, Which Creates an Unnecessary Barrier to Access Conservative, Cost-Effective Care Options
Download the UHC Patient Advocacy Flyer and Urge Your UHC Medicare Advantage Patients to Take Action!
By: Stephanie Davidson, MAC Insurance Relations Manager
On September 1, 2024, UnitedHealthcare (Optum) implemented prior authorization requirements under their Medicare Advantage plans for chiropractic care and other outpatient therapies, including PT, occupational, and speech therapy. For chiropractic care, this includes:
- CPT ® codes 98940, 98941, and 98943 (when billed with the AT modifier)
- Select physical medicine codes (if covered under the plan)
Exclusions: The prior authorization requirement does not apply to Evaluation and Management (E/M) services, so offices may need to adjust protocols accordingly. This could include implementing the following steps:
- Conducting the E/M on the initial date of service
- Submitting the preauthorization request after the initial evaluation
- Scheduling the chiropractic treatments only after the authorization has been approved
Failure to obtain authorization may result in claim denial, and providers will not be able to balance bill patients for these services.
The MAC Insurance Relations and Legal Affairs teams urge all providers to familiarize themselves with these changes and ensure that prior authorizations are obtained promptly to avoid disruptions in patient care.
The MAC continues to actively advocate on this issue on your behalf, working with national and other state chiropractic organizations to fight these changes.
We believe that this unjustified burden will create a barrier for seniors with UnitedHealthcare Medicare Advantage coverage to access a conservative, cost-effective care option. No justification exists to require additional pre-conditions for care for those seniors who have chosen a Medicare Advantage plan over those who are covered under traditional Medicare.
Getting Your Patients Involved
One way you can help in this effort is to get your patients involved! Distribute this Patient Advocacy Flyer to your UnitedHealthcare (Optum) Medicare Advantage patients and urge them to take action TODAY! The flyer explains the issue, details how it will affect your patients, and gives easy-to-follow instructions on how to contact UnitedHealthcare and urge them to tell their plan representative:
- Respect the treatment plan recommended by my physician and agreed upon by me, without unnecessary delays.
- Do not create barriers to accessing timely and effective care that helps me manage my condition without opioids.
- Stop the prior authorization requirement for chiropractic and other physical therapy care.
The involvement of patients across the state of Michigan and the nation, as well as the chiropractors who provide their care, will be critical to stopping these requirements!
Get involved TODAY and help your patients TAKE ACTION!
Additional Advocacy Efforts
The MAC knows these changes will drastically affect your practice and your patients. As noted above, we are collaborating with national organizations such as ChiroCongress and other state associations to spearhead a coordinated effort to stop these prior authorization requirements. The more chiropractors (and chiropractic patients) nationwide who get involved in this effort, the more likely these requirements can be stopped, preserving chiropractic patients’ access to conservative, drug- and surgery-free chiropractic care.
The ACA has also gotten involved, joining a coalition including the APTA, American Health Care Association, Alliance for Physical Therapy, American Speech Language Hearing Association, National Association of Rehabilitation Providers and Agencies, and others, sending a letter to UnitedHealthcare requesting “the rescission or suspension” of their prior authorization requirements. Read the letter here.
Additional Resources
- Read the UnitedHealthcare Announcement here. There you can find information on:
- Affected procedures
- Impacted plans
- How to submit a prior authorization request
