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Academy scores big wins with private payer policies

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The AADA works to maintain appropriate reimbursement for furnished services and ensure patients can access covered quality care. As the specialty’s greatest advocate, we build relationships with private payers and examine insurer coverage and payment trends affecting dermatology. This critical collaboration helps address immediate needs affecting our members’ ability to deliver care.

As a direct result of our advocacy efforts in 2022, UnitedHealthcare (UHC) agreed to amend its policies on prior authorization for Mohs and adjacent tissue transfer. These changes will improve payment for dermatologic services for appropriately reported services, which were being inappropriately reduced under UHC policy.

UHC will also adjust its multiple procedure payment reduction policy after AADA Patient Access and Payer Relations Committee leadership argued that the insurer’s policy does not fully align with that of CMS. Under Medicare, the payment reduction does not apply if surgeons of different specialties are each performing a different procedure (with specific CPT codes). In such cases, neither co-surgery nor multiple surgery rules apply (even if the procedures are performed through the same incision).

However, UHC had been applying the multiple procedure payment reduction when procedures were performed by two physicians of different specialties, but under the same Tax Identification Number (TIN), on the same patient on the same day.