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UnitedHealthcare Community Plan: September l 2020 Network Bulletin Appendix NEW YORK PAYMENT POLICY - OUTPATIENT PHYSICAL & OCCUPATIONAL SERVICES COVERED & NON-COVERED CPT CODES

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Proprietary Information of UnitedHealthcare. Copyright 2020 United HealthCare Services, Inc.

NEW YORK PAYMENT POLICY

OUTPATIENT PHYSICAL & OCCUPATIONAL SERVICES

COVERED & NON-COVERED CPT CODES

APPLICABLE CODES

Check the member benefit plan document that may supersede the Additional Considerations and Coverage Limitations

and Exclusions and Prior Authorization Requirements.

See the September 2020 Network Bulletin or for more information.

UnitedHealthcare® Community Plan

Network Bulletin Appendix

UnitedHealthcare Community Plan: September l 2020 Network Bulletin Appendix NEW YORK PAYMENT POLICY - OUTPATIENT PHYSICAL & OCCUPATIONAL SERVICES COVERED & NON-COVERED CPT CODES

Page 2 of 4

Proprietary Information of UnitedHealthcare. Copyright 2020 United HealthCare Services, Inc.

UnitedHealthcare Community Plan: September l 2020 Network Bulletin Appendix NEW YORK PAYMENT POLICY - OUTPATIENT PHYSICAL & OCCUPATIONAL SERVICES COVERED & NON-COVERED CPT CODES

Page 3 of 4

Proprietary Information of UnitedHealthcare. Copyright 2020 United HealthCare Services, Inc.

UnitedHealthcare Community Plan: September l 2020 Network Bulletin Appendix NEW YORK PAYMENT POLICY - OUTPATIENT PHYSICAL & OCCUPATIONAL SERVICES COVERED & NON-COVERED CPT CODES

Page 4 of 4

Proprietary Information of UnitedHealthcare. Copyright 2020 United HealthCare Services, Inc.

UnitedHealthcare Community Plan of New York

uhccommunityplan.com For Health Care Professionals > New York > Reimbursement Policy > Professional Non-Covered Codes Policy

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