In response to reported denials by UHC for developmental screening, clarification was obtained from Richard Justman, MD, UHC National Medical Director. As part of the standard certificate of coverage, UHC Reimbursement policy is to pay separately for developmental screening (CPT code 96110). The UHC Reimbursement policy can be accessed here.
UHC acknowledged that due to a systems error, denials were processed incorrectly for certain services. UHC is working to adjust claims that were incorrectly denied involving CPT code 96110 and there is no need for the physician to resubmit the claim.
Below is the clarification provided by UHC:
Thank you for bringing this to my attention.
No, our policy has not changed. However, we have identified a system error that has been incorrectly including certain cognitive services in other E/M codes. We have corrected this error going forward.
We will also adjust claims that have been incorrectly paid without physician need to seek individual claim adjustments. I apologize for this error. Please let me know if you have questions.
Louis A. Terranova, MHA
Senior Health Policy Analyst
Private Payer Advocacy
Department of Practice
American Academy of Pediatrics
141 Northwest Point Blvd.
Elk Grove Village, IL 60007
800/433-9016 ext. 7633
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