CPT code crosswalk table

17 What is the CPT Code Crosswalk Table?

AA The CPT Code Crosswalk Table includes a mapping of CPT codes that are interchangeable for pre-certification. For example, if a provider calls to obtain pre-certification for a left heart catheterization and provides the CPT code 93452 and ultimately bills a 93453 CPT code, the code substitution is appropriate if these codes are mapped as interchangeable on the Crosswalk Table. CPT code substitutions are not appropriate, however, if the codes are not mapped as interchangeable on the table.

For example, if a provider calls to obtain pre-certification for a pacemaker insertion (CPT Code 33206) and instead implants a defibrillator (CPT Code 33240) and these codes are not mapped as interchangeable on the Crosswalk Table, then this code substitution is inappropriate.

18 Is a pre-certification number required for each cardiac procedure ordered?

AA Yes. A pre-certification number is required for each individual CPT code and each pre-certification number is CPT code-specific. The pre-certification number does not need to be included on the claim submission as UnitedHealthcare Neighborhood Health Partnership matches claims and the associated cardiology precertifications automatically.

19 How do I know if a cardiac pre-certification is required for a UnitedHealthcare Neighborhood Health Partnership member?

AA In most cases, if a UnitedHealthcare member is enrolled in a commercial benefit plan, cardiac pre-certification is required. Neighborhood Health Partnership commercial members can be identified by a reference to myNHP.com on the back of their healthcare identification (ID) card. If the member’s health care ID card does not distinguish if coverage is a UnitedHealthcare Neighborhood Health Partnership product, pre-certification requirements can be verified by initiating the cardiology pre-certification online or by calling 866-889-8054 and providing the member’s demographic information. The support representative will continue with the pre-certification process or let you know thatpre-certification is not required.