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News & Advocacy

UHC Reverses Downcoding Decision

posted: December 11, 2018

Earlier this year, UHC announced that they would no longer reimburse complex administration codes (96413 and 96415) for four biologic drugs — Actemra, Entyvio, Orencia and Simponi. They would instead require providers to use the therapeutic codes (96365 and 96366). The new policy was supposed to be effective December 1, 2018.

Joining numerous other organizations, the OAR signed on to a letter to UHC opposing the downcoding. The letter expressed concern that the policy would limit physicians’ ability to provide these drugs in the office and threaten patients’ access to critical treatments and urged UHC to continue to reimburse administration of all biologics uniformly under the complex chemotherapy codes.

In response to an outpour of negative feedback, UHC recently announced that this new policy has been put “on hold” until further notice. The OAR will continue to work with UHC on this issue and will work to ensure the policy is not reinstated.