UHC issuing recoupments on 88305 prostate biopsies for Medicare Advantage members
We’ve recently seen many commercial payers move to only paying prostate biopsies coded G0416 instead of 88305 (for instance, Cigna will institute this rule effective Aug. 18). It’s not exactly a major surprise to see them adopting CMS guidelines on this...
As UHC limits OON lab services, questions arise on timing
At a time when patients and providers alike are being severely impacted by the COVID-19 Public Health Emergency, UnitedHealthcare (UHC) has taken the opportunity to push some aggressive policy changes to limit care — all while reaping record profits. As of July...
Cigna to cease payment for 88305 prostate biopsies
In a recent letter to providers, Cigna announced it will no longer reimburse prostate needle biopsies billed with CPT 88305 beginning Aug. 18. Instead, claims on or after that date must be submitted with HCPCS code G0416, one unit, to be eligible for payment. This...