Updated September 1, 2010

UnitedHealthcare Expands Prior Notification Program for EP Implant Services  

As previously communicated, Society members that participate in UnitedHealthcare's family of companies must obtain prior notification for select pacemaker, ICD and Bi-ventricular implant procedures.

Effective September 1, 2010, physicians based in the following states will be subject to this requirement: Alabama, Arizona, Arkansas, Delaware, Georgia, Hawaii, Illinois, Indiana, Kansas, Louisiana, Maine, Massachusetts, Michigan, Mississippi, Nevada, New Hampshire, New Mexico, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia and West Virginia.

The prior notification requirement will apply to physicians located in Colorado and Kentucky on October 1, 2010.

Download the UnitedHealthcare FAQs (PDF, 68K) and the UnitedHealthcare Reminder notice (PDF, 80K)

Prior Notification Policy for UnitedHealthcare

Beginning July 1, 2010, UnitedHealthcare will require prior notification for specific pacemaker and ICD implant procedures. The Heart Rhythm Society worked closely with UnitedHealthcare to ensure that the clinical criteria for pacemaker, ICD and biventricular implant systems are consistent with the Society's consensus statements and practice guidance.

Heart Rhythm Society members that participate in UnitedHealthcare Choice, UnitedHealthcare Choice Plus, UnitedHealthcare Select, and UnitedHealthcare Select Plus benefit plans, as well as Medicare Advantage administered by SecureHorizons® and Evercare® must obtain prior notification for select impant procedures. Affected pacemaker implant procedures have the following CPT codes: 33206, 33207, 33208, 33212, 33213, 33214, and 33225. Affected ICD implant procedures are 33240 and 33249.

Download UnitedHealthcare's Physician Guidelines: Current, Evidence-based Recommendations Regarding Cardiology (PDF, 224K)

The July 1 deadline requirement applies to members located in Florida, Missouri, North Carolina, Ohio and Wisconsin. On September 1, the prior notification program will be rolled out to all other states, with the exception of Washington, Oregon, Montana, Idaho, Wyoming, North Dakota, South Dakota, Nebraska, Minnesota, New York, Connecticut, Rhode Island, New Jersey, Maryland, District of Columbia, California and Iowa. A roll-out schedule for these states has not be determined.

UnitedHealthcare claims this protocol is not a pre-certification, pre-authorization program or medical necessity determination. A notification number must be obtained in accordance with the Cardiology Notification process prior to perform EP implant procedures. Failure to complete the notification process will result in an administrative denial. All procedures require notification regardless if they are elective or emergent.

Prior notification may be obtained online, by telephone or fax:

• Online: UnitedHealthcareOnline.com (User ID and password are required)
• Telephone: +1 (866) 889-8054
• Fax: 1 (866) 889-8061

Additional resources such as Frequently Asked Questions, a plan inclusion and exclusion grid, CPT codes and quick reference guide can be found at www.UnitedHealthcareOnline.com — click on “Clinical Resources” then click on “Cardiology.”