January Interactive Network Bulletin 2019

Transcript

1 JANUARY 2019 net work bulletin An important message from UnitedHealthcare to health care professionals and facilities. Enter UnitedHealthcare respects the expertise of the physicians, health care professionals and their staff who participate in our network. Our goal is to support you and your patients in making the most informed decisions regarding the choice of quality and cost-effective care, and to support practice staff with a simple and predictable administrative experience. The Network Bulletin was developed to share important updates regarding UnitedHealthcare procedure and policy changes, as well as other useful administrative and clinical information. Where information in this bulletin conflicts with applicable state and/or federal law, UnitedHealthcare follows such applicable federal and/or state law.

2 UnitedHealthcare Network Bulletin January 2018 Table of Contents Front & Center PAGE 3 Stay up to date with the latest news and information. UnitedHealthcare Commercial PAGE 26 Learn about program revisions and requirement updates. UnitedHealthcare PAGE 34 Reimbursement Policies Learn about policy changes and updates. UnitedHealthcare Community Plan PAGE 36 Learn about Medicaid coverage changes and updates. UnitedHealthcare Medicare Advantage PAGE 50 Learn about Medicare policy, reimbursement and guideline changes. UnitedHealthcare Affiliates PAGE 55 Learn about updates with our company partners. State News PAGE 65 Stay up to date with the latest state/regional news. UHCprovider.com 2 | For more information, call 877-842-3210 or visit .

3 UnitedHealthcare Network Bulletin January 2019 Table of Contents Front & Center Stay up to date with the latest news and information. UnitedHealthcare Care New Prior Authorization Provider Administrative Requirement for In-Patient Guide for Commercial and Cerebral Seizure Video EEG Monitoring Medicare Advantage The updated UnitedHealthcare Starting April 1, 2019, UnitedHealthcare will require prior Care Provider Administrative Guide will be available Jan. 1, 2019 on authorization for in-patient video electroencephalograph (EEG) UHCprovider.com/guides. for cerebral seizure monitoring. New and Updated This new requirement applies to Procedure Codes for CAR-T UnitedHealthcare commercial Go Paperless For a Chance and UnitedHealthcare Medicare Cell Therapy — Effective to Win $500 Advantage members. We’ve Jan. 1, 2019 Visit UHCprovider.com/paperless implemented this change as part to learn how to win $500 for your New procedure codes will become of our commitment toward the organization. You have until May effective Jan. 1, 2019 due to Triple Aim of improving health care 31, 2019 to enter, but if you go updates from the Centers for services, health outcomes and paperless now, you’ll be entered Medicare & Medicaid Services overall cost of care. into more of the monthly drawings. (CMS). Some new codes for Chimeric Antigen Receptor T-Cell (CAR-T) Therapy may also be HEDIS® Season is Here Radiology Program subject to prior authorization. Beginning in January 2019, Procedure Code Changes — we may contact you to request Effective Jan. 1, 2019 member-specific medical records. Changes in Advance Beginning Jan. 1, 2019, UnitedHealthcare is required Notification and Prior UnitedHealthcare is updating by the Centers for Medicare & Authorization Requirements the procedure code list for the Medicaid Services (CMS) to collect Radiology Notification and Prior Changes in advance notification Healthcare Effectiveness Data Authorization Programs based and prior authorization and Information Set (HEDIS®) on code changes made by the requirements result from information each year from our American Medical Association UnitedHealthcare’s ongoing participating care providers. (AMA). Claims with dates of service responsibility to evaluate our HEDIS® is a registered trademark of on or after Jan.1, 2019 are subject medical policies, clinical programs the National Committee for Quality to these changes. and health benefits compared to Assurance (NCQA). the latest scientific evidence and specialty society guidance. 3 | For more information, call 877-842-3210 or visit UHCprovider.com .

4 UnitedHealthcare Network Bulletin January 2019 Table of Contents Front & Center Stay up to date with the latest news and information. UnitedHealthcare Pharmacy Update: Notice Commercial and of Changes to Prior UnitedHealthcare Authorization Requirements Community Plan Outpatient and Coverage Criteria Injectable Cancer Therapy for UnitedHealthcare Authorization Program Commercial and Oxford Update A pharmacy bulletin outlining upcoming new or revised clinical Effective Feb. 1, 2019, Optum, programs and implementation an affiliate company of Updates to Requirements dates is now available for UnitedHealthcare, will begin for Specialty Medical UnitedHealthcare commercial plans managing our prior authorization Injectable Drugs for at UHCprovider.com/pharmacy requests for outpatient injectable chemotherapy and related cancer UnitedHealthcare therapies. This change applies Commercial, Community UnitedHealthcare Genetic to UnitedHealthcare commercial Plan and Medicare members with a cancer diagnosis. and Molecular Testing Prior Advantage Members This change also applies to Authorization/Notification We’re making some updates UnitedHealthcare Community Plan Updates to our requirements for certain members in Pennsylvania and Beginning April 1, 2019, specialty medications for many of Texas. This change does not apply UnitedHealthcare will require our UnitedHealthcare commercial, to UnitedHealthcare Community prior authorization/notification Community Plan and Medicare Plan members in New Jersey and for additional codes as part of Advantage members. These New York, as announced in the the online prior authorization/ requirements are important to November Network Bulletin. notification program for genetic provide our members access to and molecular testing performed care that’s medically appropriate in an outpatient setting for our as we work toward the Triple Aim fully insured UnitedHealthcare of improving health care services, commercial plan members and health outcomes, and overall cost UnitedHealthcare Community Plan of care. members (excluding Medicare Advantage) in Florida, Maryland, Michigan, Missouri, New Jersey, New York, Pennsylvania, Rhode Island, Tennessee and Texas. . UHCprovider.com or visit 4 | For more information, call 877-842-3210

5 UnitedHealthcare Network Bulletin January 2019 Table of Contents Front & Center Stay up to date with the latest news and information. Tell Us What You Think of Discontinuation of Reimbursement for Codes Our Communications S9083 and S9088 Please take a few minutes to complete an online survey and give Beginning April 1, 2019, us your thoughts about the Network UnitedHealthcare commercial Bulletin. plans, UnitedHealthcare Oxford and UnitedHealthcare Community Plan in some states will revise their Dental Clinical Policy policies to no longer reimburse & Coverage Guideline Healthcare Common Procedure Coding System (HCPCS) S9083, Updates Global Fee Urgent Care Center, to care providers. or visit 877-842-3210 5 | For more information, call . UHCprovider.com

6 UnitedHealthcare Network Bulletin Table of Contents January 2019 Front & Center UnitedHealthcare Care Provider Administrative Guide for UnitedHealthcare Commercial and Medicare Advantage request prior authorization for these services and Updated UnitedHealthcare Care Provider receive a determination from UnitedHealthcare before Administrative Guide Available Jan. 1, 2019* the member is admitted to a facility or a post-acute We post this essential resource for physicians, hospitals, care bed in a facility. We provided details in the UHCprovider. facilities and other health care providers on October 2018 Network Bulletin . com/guides annually on Jan. 1. • Additional Notification Requirements on patient You can view the 2019 Guide as a PDF or webpage at safety concerns and any external sanctions UHCprovider.com/guides . Be sure to save the link to or corrective actions. Chapter 2: Provider your favorites or download the PDF. Responsibilities and Standards, page 10. • Some Optum Dual Special Needs (DSNP) Protocol: Quick Reference to UnitedHealthcare members enrolled in our DSNP program may be Care Provider Administrative Guides Now eligible to participate in UnitedHealthcare Dual Special Available Needs Plans managed by Optum (UnitedHealthcare The updated Quick Reference to Provider Optum DSNPs). Optum provides the Optum Dual Administrative Guides UHCprovider. is available at Special Needs Plan at Home program. For more com/guides . We developed this resource based on care information, go to our protocol Primary Care Provider provider feedback. It contains information that you are (PCP) UnitedHealthcare Optum DSNP Policy on likely to need early and often in your relationship with . Chapter 4: Medicare UHCprovider.com/policies UnitedHealthcare. Products, page 23. You’ll see the following changes to the 2019 • Updating Advance Notifications or Prior UnitedHealthcare Care Provider Administrative Guide. This Removed references about changes Authorizations: list is not all-inclusive; refer to the updated UnitedHealthcare to previously approved prior authorization during a Care Provider Administrative Guide for specific information. procedure and after a procedure. For information on when a prior authorization or notification may be New in the 2019 Guide: updated, go to Chapter 6: Medical Management, Ten • Medical Prior Authorization Fax Retirement: page 33. fax numbers used for medical prior authorization Medicare Advantage Pharmacy Coverage Gap: • retired on Jan. 1, 2019 and more will be retired Cost shares updated for 2019 per Centers for throughout the year. We announced these changes in Medicare & Medicaid Services (CMS) guidelines. September and October 2018 Network Bulletin the Chapter 7: Specialty Pharmacy and Medicare and details can be found at UHCprovider.com/priorauth. Advantage Pharmacy, page 48. • Skilled Nursing Facilities require prior Charging Members Additional Fees for Covered • authorization: For Medicare Advantage members, Care providers may not charge a Services: facilities providing post-acute inpatient services must CONTINUED > 6 | For more information, call or visit UHCprovider.com . 877-842-3210

7 UnitedHealthcare Network Bulletin Table of Contents January 2019 Front & Center < CONTINUED UnitedHealthcare Care Provider Administrative Guide for UnitedHealthcare Commercial and Medicare Advantage • member additional fees for reductions applied to CMS Preclusion List Policy: The CMS preclusion list applies to claims with dates of service on or after services/claims resulting from our protocols and/or Jan. 1, 2019. The list applies to UnitedHealthcare reimbursement policies. Chapter 10: Compensation, Medicare Advantage plans and Part D plans. We page 69. detailed this in the October 2018 Network Bulletin Member Out of Pocket Maximums: • If you prefer to article . Chapter 16: New Preclusion List Policy collect payment at the time of service, you must make Fraud, Waste and Abuse, page 84. a good faith effort to help ensure the member has New steps Capitated and Delegated Providers: • not exceeded their annual out-of-pocket maximum and deadlines if a member exceeds their maximums. amount. Chapter 10: Compensation, page 70. Capitated and Delegated Supplement, page 123. • All Quality of Care Correspondence is Considered * Except as otherwise noted, the new guide is effective Correspondence from the Quality Confidential: of Care Department is considered privileged and on April 1, 2019 for currently contracted care providers and Jan. 1, 2019 for care providers newly contracted confidential, and should not to be shared with the patient. Chapter 11: Medical Records Standards and on or after Jan. 1, 2019. This guide applies to UnitedHealthcare commercial and Medicare Advantage Requirements, page 73. plans only. Go Paperless For a Chance to Win $500 Visit UHCprovider.com/paperless to learn how to win $500 for your organization. You have until May 31, 2019 to enter, but if you go paperless now, you’ll be entered into more of the monthly drawings. or visit . 7 | For more information, call UHCprovider.com 877-842-3210

8 UnitedHealthcare Network Bulletin Table of Contents January 2019 Front & Center Radiology Program Procedure Code Changes — Effective Jan. 1, 2019 Beginning Jan. 1, 2019, UnitedHealthcare is updating the procedure code list for the Radiology Notification and Prior Authorization Programs based on code changes made by the American Medical Association (AMA). Claims with dates of service on or after Jan.1, 2019 are subject to these changes. The following CPT® codes are being added to the Radiology Notification and Prior Authorization list: Comments Code Description Code New code replacing 77058 Magnetic resonance imaging, breast, without contrast 77046 (77058 is a deleted code as of Jan. 1, 2019) material; unilateral New code replacing 77059 Magnetic resonance imaging, breast, without contrast 77047 (77059 is a deleted code as of Jan. 1, 2019) material; bilateral Magnetic resonance imaging, breast, without and with New code replacing 77058 contrast material(s), including computer-aided detection (77058 is a deleted code as of Jan. 1, 2019) 77048 (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral New code replacing 77059 Magnetic resonance imaging, breast, without and with (77059 is a deleted code as of Jan. 1, 2019) contrast material(s), including computer-aided detection 77049 (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral The following CPT codes are being deleted from the Radiology Notification and Prior Authorization list: Comments Code Description Code Magnetic resonance imaging, breast, without and/or with Deleted code as of Jan. 1, 2019 77058 contrast material(s); unilateral Deleted code as of Jan. 1, 2019 Magnetic resonance imaging, breast, without and/or with 77059 contrast material(s); bilateral For the most current listing of CPT codes for which For complete details on this radiology protocol, UnitedHealthcare Care Provider go to the notification/prior authorization is required, go to online at UHCprovider. UHCprovider.com/Radiology > Specific Radiology Administrative Guide Administrative Guides and Programs. These requirements do not apply to advanced com > Menu > imaging procedures provided in the emergency room, urgent . Manuals care center, observation unit or during an inpatient stay. . UHCprovider.com or visit 877-842-3210 8 | For more information, call

9 UnitedHealthcare Network Bulletin Table of Contents January 2019 Front & Center New and Updated Procedure Codes for CAR-T Cell Therapy — Effective Jan. 1, 2019 New procedure codes will become effective Jan. 1, 2019 due to updates from the Centers for Medicare & Medicaid Services (CMS). The following new codes for Chimeric Antigen Receptor T-Cell (CAR-T) Therapy are subject to prior authorization. Coverage reviews for CAR-T therapy are managed by Optum Transplant Resource Services through the same process as the transplant of tissue or organs. • Q2042 – Kymriah (tisagenlecleucel) • 0537T — CAR-T therapy; harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells, per day • 0538T — CAR-T therapy; preparation of blood- derived T lymphocytes for transportation (eg, cryopreservation, storage) • 0539T -— CAR-T therapy; receipt and preparation of CAR-T cells for administration • 0540T — CAR-T therapy; CAR-T cell administration, autologous UHCprovider.com 9 | For more information, call 877-842-3210 or visit .

10 UnitedHealthcare Network Bulletin Table of Contents January 2019 Front & Center Changes in Advance Notification and Prior Authorization Requirements UnitedHealthcare Commercial, UnitedHealthcare of the Code Replacements to Prior Authorization River Valley and UnitedHealthcare West): The 2019 American Medical Association (AMA) national procedure code changes have been announced. For Code Category dates of service on or after Jan. 1, 2019 , the following prior authorization codes have been deleted and are E0986 Durable Medical Equipment (DME) replaced with procedure code(s) as noted below. This , the April 1, 2019 Effective for dates of service on or after change impacts all UnitedHealthcare entities: following procedure code will require prior authorization for UnitedHealthcare Medicare Advantage, UnitedHealthcare Replacement Code Deleted Code Category West Medicare Advantage, UnitedHealthcare Community 77046, 77048 77058 Radiology Dual Special Needs Plans, UnitedHealthcare Community Plan Massachusetts Senior Care Options, UnitedHealthcare 77047, 77049 77059 Radiology Community Plans-Medicare; and Medica and Preferred Care of Florida health plan), UnitedHealthcare Connected 81211 BRCA 81163 TX (Medicare-Medicaid plan) and MyCare Ohio (Medicare- Medicaid plan): 81164 81213 BRCA 81165, 81166 BRCA 81214 Code Category Radiology C8904 C8937 64590 Stimulators (New) C8907 Radiology Effective for dates of service on or after April 1, 2019, the following procedure code will require prior authorization for J9310 J9311, J9312 Chemotherapy UnitedHealthcare Community Plan of Ohio : C9014, C9032, J0567, J3398, Injectable C9465, C9466, J7318, J0517, medications Code Category J1301, J7170 C9493, Q9995 Transplants Breast reconstruction (non mastectomy) 19380 Q2040 CAR-T cell therapy Ten fax numbers used for medical prior authorization retired on Jan. 1, 2019 Code Additions to Prior Authorization and more will be retired throughout the year. The fax numbers are listed at Effective for dates of service on or after , April 1, 2019 UHCprovider.com/priorauth . a new code will be added to prior authorization for the following plans: UnitedHealthcare Commercial Plans (UnitedHealthcare Mid Atlantic Health Plan, Navigate, Neighborhood Health Partnership, UnitedHealthOne, CONTINUED > 10 | For more information, call 877-842-3210 or visit UHCprovider.com .

11 UnitedHealthcare Network Bulletin Table of Contents January 2019 Front & Center < CONTINUED Changes in Advance Notification and Prior Authorization Requirements Effective for dates of service April 1, 2019, the following Additional Codes Category procedure codes will add additional criteria to the Information UnitedHealthcare prior authorization requirements for E0277, E0328, E0329, Community Plan of Texas (StarPlus Plan) : E0470, E0471, E0486, DME E0652, E1130, E1825, New Current Codes Impacted E2310, E2311, E2512 Category Category L3763, L4631, L5647, L1810, L1831, L1843, Orthotics/ Orthotics/ Orthotic/ L5649, L5673, L5683, Prosthetics Prosthetics L1932, L1951, L1960, Prosthetic L5700, L5705, L5845, >$500 Regardless of L2280, L2999, L3000, L5962, L5986, L5999 L3010, L3020, L3216, Billed Amount Applies only L3221, L3960, L4631, Sleep Studies to Mississippi 95805, 95807, 95808, L5000, L5611, L5620, 95810, 95811 — Attended and Maryland L5624, L5629, L5631, plans L5637, L5645, L5647, L5649, L5650, L5671, Code Removals from Existing Prior L5673, L5679, L5685, Authorization Categories L5700, L5701, L5704, L5705, L5707, L5845, Although prior authorization requirements are being L5910, L5920, L5940, removed for certain codes, post-service determinations L5962, L5972, L5986, may still be applicable based on criteria published in L8000, L8001, L8002, medical policies, local/national coverage determination L8010, L8015, L8020, criteria and/or state fee schedule coverage. L8030, L8031, L8032, L8035, L8039, L8420, Effective immediately, the following codes will not require L8499, L8500 UnitedHealthcare Community prior authorization for Plan of Wisconsin (Medicaid) : Effective for dates of service on or after , the April 1, 2019 following procedure codes will require prior authorization Category Codes ALL plans for UnitedHealthcare Community Plan – Experimental & (excluding UnitedHealthcare Connected-TX (Medicare- A9276, A9277, A9278 investigational Medicaid Plan), UnitedHealthcare Connected for MyCareOhio (Medicare-Medicaid Plan), Massachusetts The most up-to-date Advance Notification lists Senior Care Options, and Medicare Advantage/Dual UHCProvider.com/ are available online at Special Needs plans): priorauth > Advance Notification and Plan Requirement Resources > Plan Requirement Resources. 11 | For more information, call 877-842-3210 or visit UHCprovider.com .

12 UnitedHealthcare Network Bulletin Table of Contents January 2019 Front & Center New Prior Authorization Requirement for In-Patient Cerebral Seizure Video EEG Monitoring Starting April 1, 2019, UnitedHealthcare will require prior authorization for in-patient video electroencephalograph (EEG) for cerebral seizure monitoring. This new requirement applies to UnitedHealthcare commercial and UnitedHealthcare Medicare Advantage members. We’ve implemented this change as part of our commitment toward the Triple Aim of improving health care services, health outcomes and overall cost of care. All requests for this procedure (CPT® code 95951) will be If you don’t submit a prior authorization request and subject to medical necessity and level of care review. Prior necessary documentation before performing this procedure, the claim will be denied. Care providers can’t bill members authorization isn’t required if these procedures are done in an outpatient hospital setting. for services denied due to lack of prior authorization. Members are only responsible for applicable plan -sharing. cost How to Submit a Prior Authorization Request If a non-participating or non-contracted care provider You can initiate prior authorization requests for dates of performs this procedure, members may have to pay service on or after April 1, 2019, online or by phone: additional out-of-pockets costs. Members who don’t have Use the Prior Authorization and Notification • Online: out-of-network benefits may be responsible for the entire tool on Link. Sign in to Link by going to UHCprovider. cost of services obtained from non-participating care com and clicking on the Link button in the top right providers. This doesn’t apply to members with Medicaid corner. Then, select the Prior Authorization and or DSNP plans. If a network provider refers a member Notification tile on your Link dashboard. This option to a non-participating provider without obtaining prior gives you and your patients the fastest results. You authorization, the member cannot be billed for the charges can also use the eligibilityLink tool on Link to verify and is only responsible for applicable plan cost-sharing. eligibility and benefits coverage. • Phone: If you’re unable to use the Prior Authorization We’re Here to Help and Notification tool on Link, you can continue to call Provider Services at 877-842-3210 to submit a For more information, contact your local network request by phone. management representative. Reviewing Prior Authorization Requests We’ll review the request and required clinical records, and contact the care provider and member with our coverage decision. Care providers and members will be contacted by phone and by mail. If coverage is denied, we’ll include details on how to appeal within the denial notice. 877-842-3210 12 | For more information, call UHCprovider.com . or visit

13 UnitedHealthcare Network Bulletin Table of Contents January 2019 Front & Center HEDIS® Season is Here Beginning in January 2019, we may contact you to request member-specific medical records. UnitedHealthcare is required by the Centers for Medicare & Medicaid Services (CMS) to collect Healthcare Effectiveness Data and Information Set (HEDIS®) information each year from our participating care providers. In addition to helping us meet CMS requirements, this medical record collection plays a critical role in supporting the care you provide to our members so together we can help them manage existing medical conditions and be more engaged with their preventive health. Due to the volume of records we need to collect, HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). UnitedHealthcare is working with several health information organizations, including Advantmed, Change You can find out more about medical record Healthcare, and Optum/CiOX to coordinate collection. You collection by visiting UHCprovider.com > Menu may not be contacted, since our members are randomly > Resource Library > Patient Health and Safety > selected for each HEDIS® collection cycle. If you’re . HEDIS® contacted by our health care organization, we’ll schedule a date for collection or explain the process for submitting records by mail, fax or electronically. We’ll send you a list of the requested medical records to help you prepare for the appointment or record submission. If you’re contacted, please respond within five business days to indicate your preference for medical record collection. 877-842-3210 13 | For more information, call UHCprovider.com or visit .

14 Table of Contents UnitedHealthcare Network Bulletin January 2019 Front & Center Updates to Requirements for Specialty Medical Injectable Drugs for UnitedHealthcare Commercial, Community Plan and Medicare Advantage Members We’re making some updates to our requirements for certain specialty medications for many of our UnitedHealthcare commercial, Community Plan and Medicare Advantage members. These requirements are important to provide our members access to care that’s medically appropriate as we work toward the Triple Aim of improving health care services, health outcomes, and overall cost of care. These requirements will apply whether members are new to therapy or have already been receiving these medications. of the River Valley, UnitedHealthcare Oxford, UMR, and Review at Launch Reminder Neighborhood Health Partnership: Consider requesting pre-service coverage reviews for medications listed on UnitedHealthcare’s Review at Drugs requiring notification/prior authorization and Community Plan Medication Commercial Launch If you administer any of these medications without first Lists. UnitedHealthcare adds certain new drugs to the completing the notification/prior authorization process, the Review at Launch Commercial or Community Medication claim may be denied. Members can’t be billed for services Lists once they are approved by the U.S. Food and Drug denied due to failure to complete the notification/prior Administration (FDA). Drugs will remain on the list until authorization process. we communicate otherwise. Under some benefit plans, a member may not be eligible for coverage for medications For dates of service on or after April 1, 2019, we’ll require on the Review at Launch Commercial Medication List for a notification/prior authorization for the following medications: period of time. For medications on the list, we encourage Gamifant • — The FDA recently approved Gamifant you to request pre-service coverage reviews so you can for the treatment of primary hemophagocytic check whether a medication is covered before providing lymphohistiocytosis (HLH). services. Clinical coverage reviews can also help avoid — The FDA recently approved Revcovi for the • Revcovi starting a patient on therapy that may later be denied due treatment of adenosine deaminase severe combined to lack of medical necessity. Your claims may be denied if immune deficiency (ADA- SCID) in pediatric and adult a pre-service coverage review is not completed. patients. ADA-SCID is a rare disease and an inherited genetic disorder caused by an ADA enzyme deficiency. What’s Changing for UnitedHealthcare If Revcovi is requested in the outpatient hospital setting, Commercial Plans this site of care will be reviewed for medical necessity. The following requirements will apply to UnitedHealthcare — The Centers for Medicare & Medicaid C-Codes • commercial plans, including affiliate plans such as Services (CMS) uses temporary C codes to report UnitedHealthcare of the Mid-Atlantic, UnitedHealthcare CONTINUED > . UHCprovider.com or visit 877-842-3210 14 | For more information, call

15 UnitedHealthcare Network Bulletin Table of Contents January 2019 Front & Center < CONTINUED Updates to Requirements for Specialty Medical Injectable Drugs for UnitedHealthcare Commercial, Community Plan and Medicare Advantage Members failed conservative noninvasive treatments such as drugs and biologicals that must be used by OPPS physical therapy and simple pain medicines such as (outpatient prospective payment system) facilities when no other HCPCS code is assigned. For acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Beginning April 1, 2019, injectable medications that require notification/prior authorization, all HCPCS and CPT® codes related to UnitedHealthcare will require that Synojoynt be acquired from a designated specialty pharmacy for members the drug require notification/prior authorization, even covered by UnitedHealthcare commercial plans. This is when unclassified codes (J3490, J3590, or C9399) or temporary C-codes need to be used. Correct the same process currently required for acquisition of Gel-one®, Supartz®, Hyalgan®, Orthovisc®, Gel-Syn®, coding rules dictate that assigned and permanent Gelsyn-3®,Genvisc®, Durolane®, Trivisc and Hymovis®. codes should be used when available. These requests may be subject to medical policy review Beginning April 1, 2019, we’ll include applicable as part of benefit coverage review. C-codes on our notification/prior authorization In addition, Mid-Atlantic Health Plan, Neighborhood requirement lists and in our medical benefit drug policies. C-codes for injectable medications that Health Partnership, UnitedHealthcare of the River Valley currently require prior authorization are: and Oxford Health Plans (CT and NJ) will require prior authorization/pre-certification for Synojoynt in all places • Onpattro — C9036 of service for our commercial members beginning April 1, Whether a drug is subject to notification/prior 2019. Failure to obtain preauthorization for Synojoynt may authorization requirements or not, we encourage you to result in non-payment of claims. Requests for retrospective notify us/request prior authorization so you can check authorization will not be accepted, and charges for these if a medication is covered before providing services. If products cannot be billed to members. you notify us/request prior authorization, you must wait for our determination before rendering services. What’s Changing for UnitedHealthcare Community Plan For dates of service before April 1, 2019, Gamifant and Review at Launch Revcovi have been added to the For dates of service on or after April 1, 2019, we’ll Medication List for UnitedHealthcare commercial require prior authorization for the following drugs for plans at UHCprovider.com/content/dam/provider/ UnitedHealthcare Community Plan members: docs/public/policies/attachments/review-at-launch- • Gamifant through the Review at Launch for medication-list.pdf drug policy. New to Market Medications Review at Launch Drug has been added to the Gamifant List for UnitedHealthcare Community Plan at UHCprovider. Product and Sourcing update for Hyaluronic com/en/policies-protocols/comm-planmedicaid- Acid Product — Synojoynt policies/medicaid-community-state-policies. through the Review at Launch for New to Market html for the treatment The FDA recently approved Synojoynt Medications drug policy. of osteoarthritis of the knee in patients who have CONTINUED > . UHCprovider.com or visit 877-842-3210 15 | For more information, call

16 UnitedHealthcare Network Bulletin Table of Contents January 2019 Front & Center < CONTINUED Updates to Requirements for Specialty Medical Injectable Drugs for UnitedHealthcare Commercial, Community Plan and Medicare Advantage Members All codes that would be used to bill for Gamifant will require For dates of service before April 1, 2019, we encourage you prior authorization, including any Q or C codes that CMS may to request pre-service coverage reviews so you can check assign to this medication. If Gamifant is currently not covered whether a medication is covered before providing services. in a state (due to the state agency’s review of the drug), but If you request a pre-service coverage review, you must wait then becomes covered, prior authorization will be required on for our determination before rendering the service. coverage in that state as applicable. Coverage of these drugs is also dependent on state Also effective April 1, 2019, we’ll require prior authorization Medicaid program decisions. Certain state Medicaid for the following drugs for UnitedHealthcare Community programs may choose to cover a drug through the state Plan members in certain states: fee-for-service program (and not through managed care organizations such as UnitedHealthcare). Further, the state Medicaid program may provide other coverage guidelines Program State Drug and protocols. We encourage you to verify benefits for your Actemra patients before submitting the prior authorization request or Entyvio administering the medication. Prior authorization Remicade Iowa Orencia Simponi Aria Actemra Entyvio Infliximab Prior authorization plus site of care review for Pennsylvania (Inflectra, New Jersey Remicade, the outpatient hospital Renflexis) setting. Orencia Simponi Aria CONTINUED > . UHCprovider.com or visit 877-842-3210 16 | For more information, call

17 UnitedHealthcare Network Bulletin Table of Contents January 2019 Front & Center < CONTINUED Updates to Requirements for Specialty Medical Injectable Drugs for UnitedHealthcare Commercial, Community Plan and Medicare Advantage Members • Luxturna – J3398 New and Updated Procedure Codes for Injectable Medications — Effective • Mepsevii – J3397 Jan. 1, 2019 • Onpattro – C9036 New procedure codes will take effect Jan. 1, 2019 due • Radicava – J1301 to updates from CMS. Correct coding rules dictate that • Triptodur – J3316 assigned and permanent codes should be used when available. The following injectable medications that may be • TriVisc – J7329 subject to prior authorization and/or Administrative Guide • Trogarzo – J1746 Protocols will have new codes: (immune globulin intravenous, human –ifas) Panzyga • Brineura – J0567 should be submitted on claims with code J1599, Injection, • Crysvita – J0584 immune globulin, intravenous, nonlyophilized (e.g., liquid), not otherwise specified, 500 mg. Panzyga was added to • Durolane – J7318 the Immune globulin (IVIG and SCIG) medical drug policy • Fasenra – J0517 upon FDA approval. J1599 requires prior authorization • Hemlibra – J7170 for UnitedHealthcare commercial and Community plan members. • Ilumya – J3245 • Kymriah – Q2042 Pharmacy Update: Notice of Changes to Prior Authorization Requirements and Coverage Criteria for UnitedHealthcare Commercial and Oxford A pharmacy bulletin outlining upcoming new or revised clinical programs and implementation dates is now available online for UnitedHealthcare commercial plans. Go to . UHCprovider.com/pharmacy 17 | For more information, call . UHCprovider.com or visit 877-842-3210

18 UnitedHealthcare Network Bulletin January 2019 Table of Contents Front & Center UnitedHealthcare Commercial and UnitedHealthcare Community Plan Outpatient Injectable Cancer Therapy Authorization Program Update Beginning Feb. 1, 2019, Optum, an affiliate company After answering two short questions about the state you work in, you’ll be directed to a website to process of UnitedHealthcare, will begin managing our prior these authorization requests. Prior authorization/ authorization requests for outpatient injectable chemotherapy and related cancer therapies: notification requests for UnitedHealthcare Oxford and Medicare members will continue to be requested • This change applies to UnitedHealthcare commercial though the existing eviCore process until future notice. members with a cancer diagnosis. Any active prior Prior authorization will continue to be required for: authorizations requested through the former process will remain in place. • Chemotherapy and biologic therapy injectable drugs (J9000 – J9999), Leucovorin (J0640) and • This change also applies to UnitedHealthcare Levoleucovorin (J0641) Community Plan members in Pennsylvania and Texas. Any active prior authorizations requested through • Chemotherapy and biologic therapy injectable drugs the former process will remain in place. This change that have a Q code does not apply to UnitedHealthcare Community Plan • Chemotherapy and biologic therapy injectable drugs members in New Jersey and New York, as announced that have not yet received an assigned code and will in the November Network Bulletin. be billed under a miscellaneous Healthcare Common • Prior authorization will be required for injectable Procedure Coding System (HCPCS) code chemotherapy and cancer therapy starting Feb. • Colony Stimulating Factors: 1, 2019, for UnitedHealthcare Community Plan – Filgrastim (Neupogen®) J1442 members in Louisiana. For UnitedHealthcare – Filgrastim-aafi (NivestymTM) Q5110 Community Plan in Louisiana, if the member receives injectable chemotherapy drugs in an outpatient – Filgrastim-sndz (Zarxio®) Q5101 setting from Nov. 1, 2018 through Jan. 31, 2019, you – Pegfilgrastim (Neulasta®) J2505 DO NOT need to submit a prior authorization request – Pegfilgrastim-jmdb (FulphilaTM) Q5108 until a new chemotherapy drug will be administered. – Sargramostim (Leukine®) J2820 We’ll authorize the chemotherapy regimen the – Tbo-filgrastim (Granix®) J1447 member was receiving prior to Feb. 1, 2019, and – Pegfilgrastim-cbqv, biosimilar, (Udenyca), Q5111 the authorization will be effective until Jan. 31, 2020 unless a change in treatment is needed. • Denosumab (Brand names Xgeva and Prolia): J0897 • To submit an online request for prior authorization Prior authorization will be required when adding a new through the new process, sign in to Link and access injectable chemotherapy drug or cancer therapy to an the Prior Authorization and Notification tool. Then existing regimen. select the “Radiology, Cardiology + Oncology” box. CONTINUED > 18 | For more information, call or visit UHCprovider.com . 877-842-3210

19 UnitedHealthcare Network Bulletin Table of Contents January 2019 Front & Center < CONTINUED UnitedHealthcare Commercial and UnitedHealthcare Community Plan Outpatient Injectable Cancer Therapy Authorization Program Update We’ll offer training sessions and overviews of the Optum process beginning Jan. 22, 2019. • The training schedule will be available at UHCprovider. com > Prior Authorization and Notification > Oncology > Prior Authorization for Chemotherapy and You’ll also find frequently Related Cancer Therapies. asked questions, quick references guides and other resources at this site. UHCprovider.com 19 | For more information, call 877-842-3210 . or visit

20 UnitedHealthcare Network Bulletin January 2019 Table of Contents Front & Center UnitedHealthcare Genetic and Molecular Testing Prior Authorization/Notification Updates Beginning April 1, 2019, UnitedHealthcare will require prior authorization/notification for additional codes as part of the online prior authorization/notification program for genetic and molecular testing performed in an outpatient setting for our fully insured UnitedHealthcare commercial plan members and UnitedHealthcare Community Plan members (excluding Medicare Advantage) in Florida, Maryland, Michigan, Missouri, New Jersey, New York, Pennsylvania, Rhode Island, Tennessee and Texas.* New CPT® codes included in the program: CPT Code Description Germline disorders, gene rearrangement detection by whole genome next-generation sequencing, 0012U DNA, whole blood, report of specific gene rearrangement(s) Oncology (solid organ neoplasia), gene rearrangement detection by whole genome next-generation 0013U sequencing, DNA, fresh or frozen tissue or cells, report of specific gene rearrangement(s) Hematology (hematolymphoid neoplasia), gene rearrangement detection by whole genome next- 0014U generation sequencing, DNA, whole blood or bone marrow, report of specific gene rearrangement(s) 0016U Oncology (hematolymphoid neoplasia), RNA, BCR/ABL1 major and minor breakpoint fusion transcripts, quantitative PCR amplification, blood or bone marrow, report of fusion not detected or detected with quantitation 0017U Oncology (hematolymphoid neoplasia), JAK2 mutation, DNA, PCR amplification of exons 12-14 and sequence analysis, blood or bone marrow, report of JAK2 mutation not detected or detected Oncology (colorectal), microRNA, RT-PCR expression profiling of miR-31-3p, formalin-fixed paraffin- 0069U embedded tissue, algorithm reported as an expression score 0070U CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism) gene analysis, common and select rare variants (i.e., *2, *3, *4, *4N, *5, *6, *7, *8, *9, *10, *11, *12, *13, *14A, *14B, *15, *17, *29, *35, *36, *41, *57, *61, *63, *68, *83, *xN) CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism) gene 0071U analysis, full gene sequence (List separately in addition to code for primary procedure) (Use 0071U in conjunction with 0070U) CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism) gene 0072U analysis, targeted sequence analysis (i.e., CYP2D6-2D7 hybrid gene) (List separately in addition to code for primary procedure) (Use 0072U in conjunction with 0070U) 0073U CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism) gene analysis, targeted sequence analysis (i.e., CYP2D7-2D6 hybrid gene) (List separately in addition to code for primary procedure) (Use 0073U in conjunction with 0070U) CONTINUED > UHCprovider.com 20 | For more information, call 877-842-3210 or visit .

21 UnitedHealthcare Network Bulletin January 2019 Table of Contents Front & Center < CONTINUED UnitedHealthcare Genetic and Molecular Testing Prior Authorization/ Notification Updates Description CPT Code CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism) gene 0074U analysis, targeted sequence analysis (i.e., non-duplicated gene when duplication/multiplication is trans) (List separately in addition to code for primary procedure) (Use 0074U in conjunction with 0070U) 0075U CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism) gene analysis, targeted sequence analysis (i.e., 5’ gene duplication/multiplication) (List separately in addition to code for primary procedure) (Use 0075U in conjunction with 0070U) 0076U CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (e.g., drug metabolism) gene analysis, targeted sequence analysis (i.e., 3’ gene duplication/ multiplication) (List separately in addition to code for primary procedure) (Use 0076U in conjunction with 0070U) 0078U Pain management (opioid-use disorder) genotyping panel, 16 common variants (i.e., ABCB1, COMT, DAT1, DBH, DOR, DRD1, DRD2, DRD4, GABA, GAL, HTR2A, HTTLPR, MTHFR, MUOR, OPRK1, OPRM1), buccal swab or other germline tissue sample, algorithm reported as positive or negative risk of opioid-use disorder 81167 BRCA2 (BRCA2, DNA repair associated) (e.g., hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (i.e., detection of large gene rearrangements) 81171 AFF2 (AF4/FMR2 family, member 2 [FMR2]) (e.g., fragile X mental retardation 2 [FRAXE]) gene analysis; evaluation to detect abnormal (e.g., expanded) alleles 81172 AFF2 (AF4/FMR2 family, member 2 [FMR2]) (e.g., fragile X mental retardation 2 [FRAXE]) gene analysis; characterization of alleles (e.g., expanded size and methylation status) 81173 AR (androgen receptor) (e.g., spinal and bulbar muscular atrophy, Kennedy disease, X chromosome inactivation) gene analysis; full gene sequence AR (androgen receptor) (e.g., spinal and bulbar muscular atrophy, Kennedy disease, X chromosome 81174 inactivation) gene analysis; known familial variant 81177 ATN1 (atrophin 1) (e.g., dentatorubral-pallidoluysian atrophy) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles 81178 ATXN1 (ataxin 1) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles 81179 ATXN2 (ataxin 2) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles ATXN3 (ataxin 3) (e.g., spinocerebellar ataxia, Machado-Joseph disease) gene analysis, evaluation to 81180 detect abnormal (e.g., expanded) alleles 81181 ATXN7 (ataxin 7) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles 81182 ATXN8OS (ATXN8 opposite strand [non-protein coding]) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles CONTINUED > UHCprovider.com 21 | For more information, call 877-842-3210 or visit .

22 UnitedHealthcare Network Bulletin January 2019 Table of Contents Front & Center < CONTINUED UnitedHealthcare Genetic and Molecular Testing Prior Authorization/ Notification Updates Description CPT Code ATXN10 (ataxin 10) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect abnormal (e.g., 81183 expanded) alleles 81184 CACNA1A (calcium voltage-gated channel subunit alpha1 A) (e.g., spinocerebellar ataxia) gene analysis; evaluation to detect abnormal (e.g., expanded) alleles 81185 CACNA1A (calcium voltage-gated channel subunit alpha1 A) (e.g., spinocerebellar ataxia) gene analysis; full gene sequence CACNA1A (calcium voltage-gated channel subunit alpha1 A) (e.g., spinocerebellar ataxia) gene 81186 analysis; known familial variant 81187 CNBP (CCHC-type zinc finger nucleic acid binding protein) (e.g., myotonic dystrophy type 2) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles 81188 CSTB (cystatin B) (e.g., Unverricht-Lundborg disease) gene analysis; evaluation to detect abnormal (e.g., expanded) alleles CSTB (cystatin B) (e.g., Unverricht-Lundborg disease) gene analysis; full gene sequence 81189 81190 CSTB (cystatin B) (e.g., Unverricht-Lundborg disease) gene analysis; known familial variant(s) AR (androgen receptor) (e.g., spinal and bulbar muscular atrophy, Kennedy disease, X chromosome 81204 inactivation) gene analysis; characterization of alleles (e.g., expanded size or methylation status) 81233 BTK (Bruton's tyrosine kinase) (e.g., chronic lymphocytic leukemia) gene analysis, common variants (e.g., C481S, C481R, C481F) 81234 DMPK (DM1 protein kinase) (e.g., myotonic dystrophy type 1) gene analysis; evaluation to detect abnormal (expanded) alleles EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (e.g., myelodysplastic syndrome, 81236 myeloproliferative neoplasms) gene analysis, full gene sequence 81237 EZH2 (enhancer of zeste 2 polycomb repressive complex 2 subunit) (e.g., diffuse large B-cell lymphoma) gene analysis, common variant(s) (e.g., codon 646) 81239 DMPK (DM1 protein kinase) (e.g., myotonic dystrophy type 1) gene analysis; characterization of alleles (e.g., expanded size) 81271 HTT (huntingtin) (e.g., Huntington disease) gene analysis; evaluation to detect abnormal (e.g., expanded) alleles HTT (huntingtin) (e.g., Huntington disease) gene analysis; characterization of alleles (e.g., expanded size) 81274 FXN (frataxin) (e.g., Friedreich ataxia) gene analysis; evaluation to detect abnormal (expanded) alleles 81284 81285 FXN (frataxin) (e.g., Friedreich ataxia) gene analysis; characterization of alleles (e.g., expanded size) FXN (frataxin) (e.g., Friedreich ataxia) gene analysis; full gene sequence 81286 FXN (frataxin) (e.g., Friedreich ataxia) gene analysis; known familial variant(s) 81289 CONTINUED > . 22 | For more information, call 877-842-3210 or visit UHCprovider.com

23 UnitedHealthcare Network Bulletin January 2019 Table of Contents Front & Center < CONTINUED UnitedHealthcare Genetic and Molecular Testing Prior Authorization/ Notification Updates Description CPT Code MYD88 (myeloid differentiation primary response 88) (e.g., Waldenstrom's macroglobulinemia, 81305 lymphoplasmacytic leukemia) gene analysis, p.Leu265Pro (L265P) variant 81306 NUDT15 (nudix hydrolase 15) (e.g., drug metabolism) gene analysis, common variant(s) (e.g., *2, *3, *4, *5, *6) 81312 PABPN1 (poly[A] binding protein nuclear 1) (e.g., oculopharyngeal muscular dystrophy) gene analysis, evaluation to detect abnormal (e.g., expanded) alleles PLCG2 (phospholipase C gamma 2) (e.g., chronic lymphocytic leukemia) gene analysis, common 81320 variants (e.g., R665W, S707F, L845F) SMN1 (survival of motor neuron 1, telomeric) (e.g., spinal muscular atrophy) gene analysis; dosage/ 81329 deletion analysis (e.g., carrier testing), includes SMN2 (survival of motor neuron 2, centromeric) analysis, if performed TGFBI (transforming growth factor beta-induced) (e.g., corneal dystrophy) gene analysis, common 81333 variants (e.g., R124H, R124C, R124L, R555W, R555Q) 81336 SMN1 (survival of motor neuron 1, telomeric) (e.g., spinal muscular atrophy) gene analysis; full gene sequence 81337 SMN1 (survival of motor neuron 1, telomeric) (e.g., spinal muscular atrophy) gene analysis; known familial sequence variant(s) PPP2R2B (protein phosphatase 2 regulatory subunit Bbeta) (e.g., spinocerebellar ataxia) gene analysis, 81343 evaluation to detect abnormal (e.g., expanded) alleles TBP (TATA box binding protein) (e.g., spinocerebellar ataxia) gene analysis, evaluation to detect 81344 abnormal (e.g., expanded) alleles 81345 TERT (telomerase reverse transcriptase) (e.g., thyroid carcinoma, glioblastoma multiforme) gene analysis, targeted sequence analysis (e.g., promoter region) Genetic testing for severe inherited conditions (e.g., cystic fibrosis, Ashkenazi Jewish-associated 81443 disorders [e.g., Bloom syndrome, Canavan disease, Fanconi anemia type C, mucolipidosis type VI, Gaucher disease, Tay-Sachs disease], beta hemoglobinopathies, phenylketonuria, galactosemia), genomic sequence analysis panel, must include sequencing of at least 15 genes (e.g., ACADM, ARSA, ASPA, ATP7B, BCKDHA, BCKDHB, BLM, CFTR, DHCR7, FANCC, G6PC, GAA, GALT, GBA, GBE1, HBB, HEXA, IKBKAP, MCOLN1, PAH) 81518 Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 11 genes (7 content and 4 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithms reported as percentage risk for metastatic recurrence and likelihood of benefit from extended endocrine therapy * Laboratory services ordered by Florida network providers for fully insured UnitedHealthcare commercial members in Florida will not have to participate in this requirement due to their participation in the UnitedHealthcare Laboratory Benefit Management Program. UHCprovider.com 23 | For more information, call 877-842-3210 or visit .

24 UnitedHealthcare Network Bulletin able of Contents January 2019 T Front & Center Discontinuation of Reimbursement for Codes S9083 and S9088 Beginning April 1, 2019, UnitedHealthcare commercial plans, UnitedHealthcare Oxford and UnitedHealthcare Community Plan in some states will revise their policies to no longer reimburse Healthcare Common Procedure Coding System (HCPCS) S9083, Global Fee Urgent Care Center, to care providers. Code S9083 is informational on the category of service, urgent care, not the specific service(s) provided. Consistent with CPT and the Centers for Medicare & Medicaid Services, physicians and other health care professionals should report the evaluation and management, and/or procedure code, that specifically describes the services provided. In addition, beginning April 1, 2019, UnitedHealthcare Community Plan will revise the Payment Policy to no longer reimburse HCPCS S9088, Services Provided in an Urgent Care Center, to care providers in some states. The following chart shows states impacted by these code changes: UnitedHealthcare UnitedHealthcare State Commercial & Oxford (S9083) unity Plan (S9083/S9088) Comm --- X Connecticut — X Maine X X Massachusetts New Hampshire — X X Rhode Island X Vermont — X Tell Us What You Think of Our Communications Your opinion is important to us. We’d like to get your thoughts about The Network Bulletin. Please take a few minutes today to complete the survey online at uhcresearch.az1.qualtrics.com/jfe/form/ . Thank you for your time. SV_08sAsRnUY2Kb153 UHCprovider.com 24 | For more information, call 877-842-3210 or visit .

25 UnitedHealthcare Network Bulletin Table of Contents January 2019 Front & Center Dental Clinical Policy & Coverage Guideline Updates For complete details on the policy updates listed in the following table, please at December 2018 UnitedHealthcare Dental Policy Update Bulletin refer to the UHCprovider.com > Policies and Protocols > Dental Clinical Policies and Coverage Guidelines > Dental Policy Update Bulletins . Policy Title Policy Type TAKE NOTE Annual CDT® Code Updates NEW (Effective Jan. 1, 2019) Coverage Guideline Dental Care Services in an Operating Room or Ambulatory Surgery Center Note: The inclusion of a dental service (e.g., procedure or technology) on this list does not imply that UnitedHealthcare provides coverage for the dental service. In the event of an inconsistency or conflict between the information in this bulletin and the posted policy, the provisions of the posted policy prevail. UHCprovider.com 25 | For more information, call 877-842-3210 or visit .

26 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Commercial Learn about program revisions and requirement updates. UnitedHealthcare UnitedHealthcare Medical NexusACO® Benefit Plans Policy, Medical Benefit Drug Policy and Coverage are Growing in 2019 Determination Guideline Membership in the UnitedHealthcare Updates NexusACO benefit plans is growing. Starting Jan. 1, 2019, even more members will have access to the Site of Care Reviews UnitedHealthcare NexusACO products. for Certain Advanced Outpatient Imaging Procedures — Update to UnitedHealthcare Jan. 1, 2019 Coding Update REVISED EFFECTIVE DATE: Commercial Opioid to the UnitedHealthcare Feb. 1, 2019 Programs Facility Outpatient The October 2018 Network Bulletin Beginning Jan. 1, 2019, coverage Procedure Grouper announced that as of Jan. 1, for opioid prescriptions filled at any Mapping 2019, for certain MR/CT imaging pharmacy location will be limited On Jan. 1, 2019, code updates procedures, a medical necessity to a 30-day supply. Previously, will be made to the current review for the site of care will occur OptumRx Home Delivery Pharmacy UnitedHealthcare 2018 Outpatient for UnitedHealthcare commercial prescriptions had a 30-day supply Procedure Grouper (OPG) members. To allow time for additional limit as of July 1, 2018. Now the mapping. communication and optimal rollout, limit applies to retail pharmacies site of care medical necessity as well. reviews for certain MR/CT imaging procedures will be delayed by 30 days. The new launch date will be Feb. 1, 2019. 26 | For more information, call 877-842-3210 or visit UHCprovider.com .

27 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Commercial UnitedHealthcare NexusACO® Benefit Plans are Growing in 2019 Membership in the UnitedHealthcare NexusACO benefit plans is growing. Starting Jan. 1, 2019, even more members will have access to the UnitedHealthcare NexusACO products. UnitedHealthcare NexusACO is an accountable care Health Plan Key Features organization (ACO) focused tiered product. Nationally, UnitedHealthcare NexusACO includes two benefit plans — ACOs in certain markets have been selected to be included NexusACO R and NexusACO OA — and both require that in Tier 1 for the UnitedHealthcare NexusACO benefit the member select a primary care physician (PCP). plans. While UnitedHealthcare NexusACO members can • NexusACO R requires referrals receive benefits for services from all UnitedHealthcare NexusACO participating care providers, the members may • NexusACO OA doesn’t require referrals have higher out-of-pocket costs when getting care from Refer to the member ID card to identify the member’s UnitedHealthcare NexusACO participating care providers benefit plan. The ID card will also show if a referral is who are not in Tier 1. required. Standard prior authorization and notification Tier 1 care providers will have the Tier 1 requirements, listed in UnitedHealthcare Administrative graphic by their name in the UnitedHealthcare Guide , apply. NexusACO care provider directory. If you’re not If UnitedHealthcare NexusACO is available in sure if you’re a NexusACO Tier 1 care provider, your area, you can find more information at you can check at UHCprovider.com > Menu > Menu > Health Plans by UHCprovider.com > Find a Care Provider > NexusACO Care State > choose your state > UnitedHealthcare Provider Directory. NexusACO. You can also watch an on- demand video overview of NexusACO — go to UHCprovider.com/uhconair to learn more. 877-842-3210 or visit UHCprovider.com . 27 | For more information, call

28 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Commercial Jan. 1, 2019 Coding Update to the UnitedHealthcare Facility Outpatient Procedure Grouper Mapping There are no other grouper level assignment changes On Jan. 1, 2019, the following code updates will be to existing codes. For reimbursement under the OPG, made to the current UnitedHealthcare 2018 Outpatient Procedure Grouper (OPG) mapping: UnitedHealthcare requires the appropriate line level CPT/ Healthcare Common Procedure Coding System (HCPCS) • Expired codes — 24 OPG 0-10 codes expire on code, in addition to the revenue code, when billing for Dec. 31, 2018. The codes will be deleted from the outpatient procedures. UnitedHealthcare OPG Exhibit on Jan. 1, 2019. An additional 6 OPG unlisted codes expire and will be The updated 2018 UnitedHealthcare OPG deleted as well. Exhibit is available at UHCprovider.com/ OPG 0-10 codes will — 57 under the Outpatient Procedure Grouper • Newly Published codes claims Exhibits section. be added to the UnitedHealthcare OPG Exhibit on Jan. 1, 2019. An additional 1 OPG unlisted codes will be added as well. Update to UnitedHealthcare Commercial Opioid Programs Beginning Jan. 1, 2019, coverage for opioid prescriptions filled at any pharmacy location will be limited to a 30-day supply. Previously, OptumRx Home Delivery Pharmacy prescriptions had a 30-day supply limit as of July 1, 2018. Now the limit applies to retail pharmacies as well. For more information about additional opioid > Menu > Resources > Drug Lists & Pharmacy. UHCprovider.com programs, visit or visit . 28 | For more information, call 877-842-3210 UHCprovider.com

29 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Commercial UnitedHealthcare Medical Policy, Medical Benefit Drug Policy and Coverage Determination Guideline Updates For complete details on the policy updates listed in the following table, please refer at UHCprovider.com > to the December 2018 Medical Policy Update Bulletin Menu > Policies and Protocols > Commercial Policies > Commercial Medical & Drug Policies and Coverage Determination Guidelines > Medical Policy Update Bulletins . Effective Date Policy Title Policy Type TAKE NOTE Annual CPT® and HCPCS Code Updates UPDATED/REVISED Abnormal Uterine Bleeding and Uterine Fibroids Medical Jan. 1, 2019 Athletic Pubalgia Surgery Dec. 1, 2018 Medical Medical Jan. 1, 2019 Attended Polysomnography for Evaluation of Sleep Disorders Medical Balloon Sinus Ostial Dilation Jan. 1, 2019 Drug Dec. 1, 2018 Botulinum Toxins A and B Dec. 1, 2018 Bronchial Thermoplasty Medical Chemosensitivity and Chemoresistance Assays in Cancer Medical Dec. 1, 2018 Dec. 1, 2018 Clinical Trials CDG Computed Tomographic Colonography Dec. 1, 2018 Medical Computerized Dynamic Posturography Medical Dec. 1, 2018 Medical Core Decompression for Avascular Necrosis Dec. 1, 2018 Dec. 1, 2018 Corneal Hysteresis and Intraocular Pressure Measurement Medical Cytological Examination of Breast Fluids for Cancer Screening Dec. 1, 2018 Medical Medical Discogenic Pain Treatment Dec. 1, 2018 Durable Medical Equipment, Orthotics, Ostomy Supplies, Medical Jan. 1, 2019 CDG Supplies and Repairs/Replacements CONTINUED > . 29 | For more information, call 877-842-3210 or visit UHCprovider.com

30 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Commercial < CONTINUED UnitedHealthcare Medical Policy, Medical Benefit Drug Policy and Coverage Determination Guideline Updates Effective Date Policy Title Policy Type UPDATED/REVISED Electrical Bioimpedance for Cardiac Output Measurement Dec. 1, 2018 Medical Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation Medical Jan. 1, 2019 Embolization of the Ovarian and Iliac Veins for Pelvic Dec. 1, 2018 Medical Congestion Syndrome Drug Dec. 1, 2018 Enzyme Replacement Therapy Epiduroscopy, Epidural Lysis of Adhesions and Functional Dec. 1, 2018 Medical Anesthetic Discography Femoroacetabular Impingement Syndrome Medical Jan. 1, 2019 Gastrointestinal Motility Disorders, Diagnosis and Treatment Medical Dec. 1, 2018 High Frequency Chest Wall Compression Devices Medical Dec. 1, 2018 Medical Dec. 1, 2018 Home Traction Therapy Dec. 1, 2018 Medical Intrauterine Fetal Surgery Dec. 1, 2018 Medical Laser Interstitial Thermal Therapy Light and Laser Therapy for Cutaneous Lesions and Pilonidal Disease Medical Dec. 1, 2018 Medical Dec. 1, 2018 Lithotripsy for Salivary Stones Minimally Invasive Procedures for Gastroesophageal Reflux Medical Dec. 1, 2018 Disease (GERD) Molecular Oncology Testing for Cancer Diagnosis, Prognosis, Jan. 1, 2019 Medical and Treatment Decisions Dec. 1, 2018 Motorized Spinal Traction Medical Dec. 1, 2018 Medical Nerve Graft to Restore Erectile Function During Radical Prostatectomy Neurophysiologic Testing and Monitoring Medical Jan. 1, 2019 Medical Jan. 1, 2019 Occipital Neuralgia and Headache Treatment Onpattro™ (Patisiran) Drug Dec. 1, 2018 Plagiocephaly and Craniosynostosis Treatment Medical Dec. 1, 2018 Medical Platelet Derived Growth Factors for Treatment of Wounds Dec. 1, 2018 Preterm Labor Management Medical Dec. 1, 2018 Preventive Care Services CDG Jan. 1, 2019 CONTINUED > UHCprovider.com 30 | For more information, call 877-842-3210 or visit .

31 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Commercial < CONTINUED UnitedHealthcare Medical Policy, Medical Benefit Drug Policy and Coverage Determination Guideline Updates Policy Title Policy Type Effective Date UPDATED/REVISED Prolotherapy for Musculoskeletal Indications Medical Dec. 1, 2018 Drug Dec. 1, 2018 Self-Administered Medications Sensory Integration Therapy and Auditory Integration Training Dec. 1, 2018 Medical Specialty Medication Administration — Site of Care Review Guidelines URG Jan. 1, 2019 Thermography Medical Dec. 1, 2018 Medical Dec. 1, 2018 Virtual Upper Gastrointestinal Endoscopy Visual Information Processing Evaluation and Orthoptic Dec. 1, 2018 Medical and Vision Therapy Dec. 1, 2018 Warming Therapy and Ultrasound Therapy for Wounds Medical Whole Exome and Whole Genome Sequencing Medical Jan. 1, 2019 Note: The inclusion of a health service (e.g., test, drug, device or procedure) on this list does not imply that UnitedHealthcare provides coverage for the health service. In the event of an inconsistency or conflict between the information in this bulletin and the posted policy, the provisions of the posted policy prevail. UHCprovider.com 31 | For more information, call 877-842-3210 or visit .

32 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Commercial Site of Care Reviews for Certain Advanced Outpatient Imaging Procedures — REVISED EFFECTIVE DATE: Feb. 1, 2019 The October 2018 Network Bulletin announced that as of Jan. 1, 2019, for certain MR/CT imaging procedures, a medical necessity review for the site of care will occur for UnitedHealthcare commercial members. To allow time for additional communication and optimal rollout, site of care medical necessity reviews for certain MR/CT imaging procedures will be delayed by 30 days. The new launch date will be Feb. 1, 2019. Please see details below. UnitedHealthcare aims to minimize out-of-pocket costs for UnitedHealthcare UHCprovider.com > 01/01/2019 — UnitedHealthcare members and to improve cost efficiencies Commercial Medical Policy Update Bulletin: January 2019 for the overall health care system. For dates of service on or . after Feb. 1, 2019, once prior authorization is requested for We will not conduct site of care reviews if the procedure certain advanced outpatient imaging procedures pursuant is planned to be performed in a free-standing diagnostic to our Outpatient Radiology Notification/Prior Authorization radiology center or an office setting. Protocol, we’ll review the site of care. We will issue a medical necessity determination for the site of care, under Site of care reviews will apply to providers in all states, the terms of the member’s benefit plan, if permitted by state except Alaska, Iowa, Kentucky, Utah and Wisconsin. law and if the procedure will be performed in an outpatient hospital setting. We’re also implementing a utilization Site of Care reviews will apply to UnitedHealthcare review guideline to facilitate our site of care reviews. commercial benefit plans, including exchange benefit Starting Feb. 1, 2019, the guideline will be available plans and the following benefit plans: at UHCprovider.com/policies > Commercial Policies > • Neighborhood Health Partnership Medical & Drug Policies and Coverage Determinations • UnitedHealthcare of the River Valley for UnitedHealthcare Commercial Plans . Until then, you can find it in the January Medical Policy Update at • UnitedHealthcare Site of care reviews will apply to the following procedure codes, which are currently subject to notification/prior authorization requirements: CT MR 70450, 70460, 70470, 70480 70336, 70540, 70542, 70543 70544, 70545, 70546, 70547 70548, 70549 70481, 70482, 70486, 70487, 70488 70551, 70552, 70553, 70554, 70555, 71550, 71551, 71552 CONTINUED > 32 | For more information, call . UHCprovider.com or visit 877-842-3210

33 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Commercial < CONTINUED Site of Care Reviews for Certain Advanced Outpatient Imaging Procedures — REVISED EFFECTIVE DATE: Feb. 1, 2019 MR CT 70490, 70491, 70492, 70496, 70498 72141, 72142, 72146, 72147, 72148, 72149 71250, 71260, 71270, 71275 72156, 72157, 72158, 72195, 72196, 72197 73218, 73219, 73220, 73221, 73222, 73223, 73718, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 73719, 73720, 73721, 73722, 73723 72132, 72133, 72191, 72192, 72193, 72194 74181, 74182, 74712, 74713, 75557, 75559 73200, 73201, 73202, 73206 75561, 75563, 76498, 77021 73700, 73701, 73702 77084, 71555, 72159*, 72198 73706, 74150, 74160, 74170 74174, 74175, 74176, 74177, 74178 73225*,73725, 74183, 74185 74261, 74262, 74263* 77046, 77047, 77048, 77049 C8900, C8901, C8902, C8903 75571*, 75572, 75573, 75574 75635, 76380 C8905, C8906 C8908, C8909, C8910, C8911 76497, S8092*, G0297 C8912, C8913, C8914, C8918 G0297, C8919, C8920, C8931* C8932*, C8933*, C8934* C8935*, C8936* S8037*, S8042* You may complete the notification/prior authorization To view a complete list of procedure codes process or confirm a coverage decision online or by phone: for which notification/prior authorization is required pursuant to our Outpatient Radiology • Online at . Select the UHCprovider.com/radiology Notification/Prior Authorization Protocol, please Go to Prior Authorization and Notification App, or > Prior Authorization visit: UHCprovider.com . and Notification > Radiology (7 a.m. to 7 p.m., local time, 866-889-8054 • Call Monday – Friday) As a reminder, care providers are not required to complete the notification/prior authorization process for any advanced outpatient imaging procedure rendered in the emergency room, urgent care center, observation unit or during an inpatient stay. UHCprovider.com 33 | For more information, call 877-842-3210 or visit .

34 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Reimbursement Policies Learn about policy changes and updates. Unless otherwise noted, the UnitedHealthcare Coordinated Commercial following reimbursement policies Community Plan Reimbursement Policy apply to services reported using Reimbursement Policy: Announcement the 1500 Health Insurance Claim UnitedHealthcare will implement Reimbursement policies that apply Form (CMS-1500) or its electronic several commercial reimbursement to UnitedHealthcare Community equivalent or its successor form. policy enhancements. Plan members are located here: UnitedHealthcare reimbursement UHCprovider.com > Menu > Health policies do not address all Plans by State > [Select State] factors that affect reimbursement > “View Offered Plan Information” for services rendered to under the Medicaid (Community UnitedHealthcare members, Plan) section > Bulletins and including legislative mandates, Newsletters. We encourage you member benefit coverage to regularly visit this site to view documents, UnitedHealthcare reimbursement policy updates. medical or drug policies, and the UnitedHealthcare Care Provider Administrative Guide. Meeting the terms of a particular reimbursement policy is not a guarantee of payment. Once implemented, the policies may be viewed in their UHCprovider.com > entirety at Menu > Policies and Protocols > Commercial Policies > Reimbursement Policies for . In the event Commercial Plans of an inconsistency between the information provided in the Network Bulletin and the posted policy, the posted policy prevails. UHCprovider.com or visit 877-842-3210 34 | For more information, call .

35 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Reimbursement Policies Coordinated Commercial Reimbursement Policy Announcement The following chart contains an overview of the policy changes and their effective . dates for the following policy: Evaluation and Management (E/M) Policy Effective Date Policy Summary of Change Quarter 2, 2019 • The Evaluation and Management (E/M) Policy provides guidance on the Evaluation and selection of E/M, including information for scoring and interpretation of Management (E/M) Policy services defined by E/M procedure codes. • The selection of the appropriate level of complexity and level of service must be reflected in the medical record documentation. • Currently, providers submitting claims for E/M services may have their E/M code denied when the medical record documentation does not support the E/M level submitted. • Effective Quarter 2, 2019, providers may experience adjustments to the submitted level 4 or 5 E/M code to reflect an appropriate level E/M code or may receive a denial based on the medical record documentation. UHCprovider.com 35 | For more information, call 877-842-3210 or visit .

36 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Community Plan Learn about Medicaid coverage changes and updates. Outpatient Injectable UnitedHealthcare Genetic Cancer Therapy Prior and Molecular Lab Authorization Requirement Testing Notification/Prior for UnitedHealthcare Authorization Requirement Community Plan in California As previously announced, effective and Iowa Feb. 1, 2019, UnitedHealthcare will require prior authorization/ Effective April 1, 2019, prior notification for genetic and authorization for outpatient molecular testing performed injectable chemotherapy and in an outpatient setting for related cancer therapies listed UnitedHealthcare Community Plan below will be required for members (excluding Medicare UnitedHealthcare UnitedHealthcare Community Advantage) in Maryland, Michigan, Plan members in California and Community Plan Missouri, New York, Rhode Iowa. Optum, an affiliate company Significantly Expanded Dual Island, Tennessee and Texas. of UnitedHealthcare, will manage Special Needs Program UnitedHealthcare Community Plan these prior authorization requests. — UnitedHealthcare Dual members (excluding Medicare Complete Advantage) in Florida, New Jersey and Pennsylvania, originally UnitedHealthcare On Jan. 1, 2019, UnitedHealthcare scheduled to deploy on Feb. 1, will began serving eligible members Community Plan 1st Quarter now deploy on April 1, 2019. in a Dual Special Needs Plan 2019 Preferred Drug List (DSNP) — United Healthcare Dual UnitedHealthcare Community Complete, a Medicare Advantage Plan’s Preferred Drug List (PDL) is plan — in almost 250 new counties updated quarterly by our Pharmacy across the United States. This and Therapeutics Committee. expansion includes two states Review the changes and update new to the Dual Complete offering, your references as necessary. Kentucky and Maryland, and 16 states that will include new service areas. UHCprovider.com . 36 | For more information, call or visit 877-842-3210

37 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Community Plan Learn about Medicaid coverage changes and updates. Cultural Competency UnitedHealthcare Urgent Care Centers: Training for Care Providers Community Plan Medical Payment Policy Change for Policy, Medical Benefit Codes S9083 and S9088 Cultural competency is a set of skills Drug Policy and Coverage we’re required to disclose about Effective April 1, 2019, care providers who see Medicaid Determination Guideline UnitedHealthcare Community members. You may already have Plan in Tennessee will no longer Updates completed cultural competency reimburse certain HCPCS codes. training as part of requirements for These codes are informational obtaining privileges at the hospital/ and merely indicate the type of facility where you practice. The reimbursement and place of good news is that training counts service. These codes do not toward cultural competency training adequately describe the specific for UnitedHealthcare Community service(s) provided. The affected Plan as well. HCPCS codes are S9083 (Global Fee Urgent Care Center) and S9088 (Services provided in an Maryland HealthChoice urgent care center). Provider Enrollment Requirement The Maryland Department of Health (MDH) now requires all care providers who bill for services provided to HealthChoice Medical Assistance Program (Medicaid) recipients to enroll in the electronic Provider Revalidation and Enrollment Portal (ePREP). Care providers must register and maintain their demographic information with UnitedHealthcare and the ePREP portal to receive reimbursement. . UHCprovider.com or visit 877-842-3210 37 | For more information, call

38 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Community Plan UnitedHealthcare Community Plan Significantly Expanded Dual Special Needs Program — UnitedHealthcare Dual Complete On Jan. 1, 2019, UnitedHealthcare began serving eligible members in a Dual Special Needs Plan (DSNP) — United Healthcare Dual Complete, a Medicare Advantage plan — in almost 250 new counties across the United States. This expansion includes two states new to the Dual Complete offering, Kentucky and Maryland, and 16 states with new service areas. DSNP is a Medicare Advantage plan for members who qualify for both Medicare and Medicaid. DSNPs are a specialized type of Medicare Advantage Prescription Drug Plan (MAPD) and must follow existing Centers for Medicare & Medicaid Services (CMS) rules. Here’s a list of these states and counties that launched the Michigan — Allegan, Barry, Bay, Calhoun, Kalamazoo, plan on Jan. 1, 2019: Kent, Mecosta, Montcalm, Newaygo, Ottawa, Saginaw, Sanilac, St. Joseph and Van Buren New State: Kentucky — Boone, Bullitt, Campbell, Fayette, — George, Holmes, Lawrence, Marion, Franklin, Hardin, Jefferson, Jessamine, Kenton, Larue, Mississippi Madison, Marion, Nelson, Oldham, Shelby, Spencer and Quitman, Scott, Simpson, Smith, Stone and Yazoo Woodford Missouri -— Andrew, Audrain, Barry, Barton, Bates, New State: Maryland Caldwell, Camden, Carroll, Clinton, Cooper, Howard, — Montgomery Iron, Madison, Maries, McDonald, Moniteau, Monroe, Colorado — Larimer Montgomery, Pike, St. Clair and Vernon — Kent and Sussex Delaware — Adams, Buffalo, Burt, Dodge, Gage, Hall, Nebraska — Appanoose, Benton, Black Hawk, Boone, Bremer, Iowa Madison, Otoe, Saline, Saunders, Seward and Washington Buchanan, Butler, Carroll, Cedar, Chickasaw, Clarke, New Mexico — Chaves, Colfax, Curry, Quay and Torrance Clayton, Clinton, Davis, Delaware, Des Moines, Fayette, New York Floyd, Greene, Grundy, Guthrie, Hamilton, Hardin, Henry, — Allegany, Cattaraugus, Cayuga, Chemung, Iowa, Jackson, Jefferson, Johnson, Jones, Keokuk, Chenango, Clinton, Columbia, Cortland, Delaware, Essex, Genesee, Greene, Hamilton, Herkimer, Lewis, Livingston, Linn, Louisa, Lucas, Mahaska, Marion, Mills, Monroe, Muscatine, Pottawattamie, Poweshiek, Scott, Tama, Van Madison, Montgomery, Ontario, Orleans, Oswego, Buren, Wapello, Washington, Wayne and Webster Putnam, Saratoga, Schenectady, Schoharie, Schuyler, Seneca, Steuben, Sullivan, Warren, Washington, Wayne, — Acadia, Assumption, Bienville, Bossier, Louisiana Wyoming and Yates Caddo, Claiborne, De Soto, Evangeline, Iberia, Lafayette, Ouachita, Pointe Coupee, Rapides, Red River, St. Landry, — Knox, Richland, Ross, Scioto and Washington Ohio St. Mary, Vermilion, Webster and West Feliciana CONTINUED > 38 | For more information, call 877-842-3210 UHCprovider.com . or visit

39 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Community Plan < CONTINUED UnitedHealthcare Community Plan Significantly Expanded Dual Special Needs Program — UnitedHealthcare Dual Complete Oklahoma — Adair, Cherokee, Craig, Creek, Delaware, Grady, Muskogee, Osage, Seminole, Sequoyah, Tulsa and Wagoner Pennsylvania — Cumberland, Forest, Franklin, Huntingdon, Jefferson, Juniata, Monroe, Perry, Snyder, Susquehanna, Venango and Wyoming Tex a s — Anderson, Bandera, Cherokee, Clay, Cooke, Delta, Ector, Falls, Fannin, Hill, Hopkins, Howard, Hunt, Matagorda, Medina, Midland, Montague, Rains, Red River, Starr, Tom Green, Wharton, Wise and Zavala — Benton, Walla Walla and Whatcom Washington Wisconsin — Clark, Door, Iron, Juneau and Lafayette The UnitedHealthcare Dual Complete Program will reimburse claims according to your UnitedHealthcare contractual Medicare Advantage payment appendix. for additional Visit UHCprovider.com information on the Dual Complete Plan. UHCprovider.com 39 | For more information, call 877-842-3210 or visit .

40 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Community Plan UnitedHealthcare Genetic and Molecular Lab Testing Notification/Prior Authorization Requirement As previously announced, effective Feb. 1, 2019, UnitedHealthcare will require prior authorization/notification for genetic and molecular testing performed in an outpatient setting for UnitedHealthcare Community Plan members (excluding Medicare Advantage) in Maryland, Michigan, Missouri, New York, Rhode Island, Tennessee and Texas. UnitedHealthcare Community Plan members (excluding Medicare Advantage) in Florida, New Jersey and Pennsylvania, originally scheduled to deploy on Feb. 1, will now deploy on April 1, 2019. Care providers will use the Genetic and Molecular – 0004M Lab Test tool on Link to submit the notification/ – 0006M ‒ 0007M prior authorization request. You’ll fill in the member’s – 0009M information and choose the test and the lab to perform the – 0011M ‒ 0013M test. Ordering providers will need to submit requests for – 81105 ‒ 81111 tests that require authorization. Labs may submit their own – 81120 ‒ 81121 notification requests for tests that only require notification. – 81161 ‒ 81420 The following will require notification/prior authorization: – 81425 ‒ 81479 • Tier 1 Molecular Pathology Procedures – 81507 • Tier 2 Molecular Pathology Procedures – 81519 ‒ 81521 • Genomic Sequencing Procedures – 81545 • Multianalyte Assays with Algorithmic Analyses that – 81595 ‒ 81599 include Molecular Pathology Testing – S3870 • These CPT® codes are: You’ll get a decision right away when you submit your – 0001U request online if your request meets UnitedHealthcare’s clinical and coverage guidelines. If more information or – 0018U ‒ 0019U clinical documentation is needed, we’ll contact you. – 0022U ‒ 0023U – 0026U ‒ 0034U You can find more information on the Genetic – 0036U ‒ 0037U and Molecular Lab Test tool on Link at – 0040U . Determinations UHCprovider.com/genetics for notification/ prior authorization requests will – 0045U ‒ 0050U be made based on UnitedHealthcare’s clinical – 0055U ‒ 0057U policy requirements for coverage. Our clinical – 0060U policies are at UHCprovider.com/policies . or visit 40 | For more information, call . 877-842-3210 UHCprovider.com

41 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Community Plan Outpatient Injectable Cancer Therapy Prior Authorization Requirement for UnitedHealthcare Community Plan in California and Iowa Effective April 1, 2019, prior authorization for outpatient injectable chemotherapy and related cancer therapies listed below will be required for UnitedHealthcare Community Plan members in California and Iowa. Optum, an affiliate company of UnitedHealthcare, will manage these prior authorization requests. • Denosumab (Brand names Xgeva and Prolia): J0897 To submit an online request for prior authorization, sign in to Link and access the Prior Authorization and Notification Prior authorization will be required when adding a new tool. Select the “Radiology, Cardiology + Oncology” box. injectable chemotherapy drug or cancer therapy to an After answering two short questions about the state you existing regimen. work, you will be directed to another website to process For UnitedHealthcare Community Plan in California, if the these authorization requests. member receives injectable chemotherapy drugs in an Prior authorization will continue to be required for: outpatient setting from Jan. 1, 2019 through March 31, • Chemotherapy and biologic therapy injectable 2019, you DO NOT need to submit a prior authorization drugs (J9000 – J9999), Leucovorin (J0640) and request until a new chemotherapy drug will be administered. We’ll authorize the chemotherapy regimen Levoleucovorin (J0641) the member was receiving prior to April 1, 2019, and the • Chemotherapy and biologic therapy injectable drugs authorization will be effective until March 31, 2020 unless that have a Q code a change in treatment is needed. • Chemotherapy and biologic therapy injectable drugs that have not yet received an assigned code and will be billed under a miscellaneous Healthcare Common Procedure Coding System (HCPCS) code • Colony Stimulating Factors: – Filgrastim (Neupogen®) J1442 – Filgrastim-aafi (NivestymTM) Q5110 – Filgrastim-sndz (Zarxio®) Q5101 – Pegfilgrastim (Neulasta®) J2505 – Pegfilgrastim-jmdb (FulphilaTM) Q5108 – Sargramostim (Leukine®) J2820 – Tbo-filgrastim (Granix®) J1447 – Pegfilgrastim-cbqv, biosimilar, (Udenyca), Q5111 or visit 41 | For more information, call . UHCprovider.com 877-842-3210

42 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Community Plan UnitedHealthcare Community Plan 1st Quarter 2019 Preferred Drug List UnitedHealthcare Community Plan’s Preferred Drug List (PDL) is updated quarterly by our Pharmacy and Therapeutics Committee. Review the changes and update your references as necessary. If a preferred alternative is not appropriate, call 800-310-6826 Not all medications will be added, modified or deleted in for prior authorization for the UnitedHealthcare Community each state, so check the state’s PDL for a state-specific Plan member to remain on their current medication. list of preferred drugs. You may also view the changes at UHCprovider.com > Menu > [select Health Plans by State Changes will be effective Jan. 1, 2019 for Arizona, your state]. California, Florida — Florida Healthy Kids, Hawaii, We provided a list of available alternatives to Maryland, Mississippi, Nebraska, Nevada, New Jersey, New York, Ohio, Pennsylvania, Rhode Island and Virginia. UnitedHealthcare Community Plan members whose The changes will be effective Feb. 1, 2019 for Louisiana. current treatment includes a medication removed from the PDL. Please provide effected members a prescription for a These changes don’t apply to UnitedHealthcare preferred alternative in one of the following ways: Community Plans in Florida Managed Managed Medicaid, Iowa, Kansas, Michigan, Texas and Washington. • Call or fax the pharmacy. • Use e-Script. • Write a new prescription and give it directly to the member. PDL Additions Brand Name Generic Name Comments Indicated for the treatment of non-metastatic castration resistant prostate Erleada™ Apalutamide tablet cancer. Prior authorization required. Available through specialty pharmacy. Clostridium difficile Indicated for the treatment of Vancomycin powder -associated diarrhea and Firvanq™ enterocolitis caused by Staphylococcus aureus . Diagnosis required. for oral solution Desmopressin acetate Indicated for the treatment of nocturnal polyuria. Prior authorization Nocdurna® required. sublingual tablet PDL Modifications Brand Name Generic Name Comments Pregabalin capsule and Remove prior authorization for seizure disorder only. Diagnosis required. Lyrica® oral solution Regranex® Remove prior authorization. Diagnosis required. Becaplermin gel CONTINUED > . UHCprovider.com or visit 877-842-3210 42 | For more information, call

43 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Community Plan < CONTINUED UnitedHealthcare Community Plan 1st Quarter 2019 Preferred Drug List PDL Modifications Brand Name Comments Generic Name Fluticasone furoate/ Fluticasone/salmeterol (authorized generic of AirDuo Breo Ellipta vilanterol trifenatate RespiClick®) is an alternate option. Current users will not be inhaler grandfathered. Linaclotide capsule Trulance® is an alternate option. Current users will not be grandfathered. Linzess® Basaglar® is an alternate option. Current users will not be grandfathered. Insulin glargine pen Toujeo® Firvanq is an alternate option. Current users will be Vancocin Vancomycin capsule grandfathered through the remainder of their current course of therapy. Creon® is an alternate option. Current users with cystic Pancrelipase delayed- Zenpep® fibrosis will be grandfathered. Patients using Zenpep for release capsule indications other than cystic fibrosis will not be grandfathered. PDL Update Training on UHC On Air Go to UHC On Air to check out an on-demand video highlighting this quarter’s more impactful PDL changes: • UnitedHealthcare Link users can access UHC On Air by selecting the UHC On Air tile on their Link dashboard. From there, go to your state and click on UnitedHealthcare Community Plan. You’ll find the Preferred Drug List Q1 Update in the video listings. by UHCprovider.com • To access Link, sign in to clicking the Link button in the top right corner. If you don’t have access to Link, select the New User button. If you have any questions, call UnitedHealthcare Community Plan’s Pharmacy Department at . 800-310-6826 UHCprovider.com 43 | For more information, call 877-842-3210 or visit .

44 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Community Plan Cultural Competency Training for Care Providers Cultural competency is a set of skills we’re required to disclose about care providers who see Medicaid members. The training for cultural competency covers a broad range of topics. You may already have completed cultural competency We also ask care providers to attest to cultural training as part of requirements for obtaining privileges at competencies available to their patients and update this the hospital/facility where you practice. The good news is information as it changes. Care providers with access to My Patient Profile can update this information online. that training counts toward cultural competency training Periodically, you may receive a request from us to update for UnitedHealthcare Community Plan as well. your demographic information. The information we We request information from the following areas from request includes a section for cultural competency skills our network care providers to have updated cultural and services you provide to certain populations. competency information, which we include in provider directories: Resources on cultural competency • Communications skills: interpreter services (CS) For more information — including quick reference guides • Communications skills: language availability (CLA) and videos to help with using My Practice Profile — visit . UHCprovider.com/mpp • Communications skills: soft skills (CSS) • Financially Challenged Patients (FCP) If you need information about cultural or UHCprovider.com competency, visit • Homeless (HL) the Health and Human Services website at • LGBT communities (LGB) cccm.thinkculturalhealth.hhs.gov . • People with disabilities (PWD) If you have questions, call Provider Services • Refugee or immigrant patients (RIP) . 877-842-3210 at • Senior care (SC) • Unspecified (UNS) or visit 44 | For more information, call . UHCprovider.com 877-842-3210

45 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Community Plan Maryland HealthChoice Provider Enrollment Requirement The Maryland Department of Health (MDH) now requires all care providers who bill for services provided to HealthChoice Medical Assistance Program (Medicaid) recipients to enroll in the electronic Provider Revalidation and Enrollment Portal (ePREP). Care providers must register and maintain their demographic information with UnitedHealthcare and the ePREP portal to receive reimbursement. What You Need to Do ePREP Resources website and Care Providers should visit the MDH ePREP The Maryland Department of Health has resources to help do the following: with ePREP enrollment: • Webinar and training: 1. Create a user profile. MDH ePREP Website • Frequently asked questions: MDH ePREP FAQ 2. Create and/or join a business profile 3. Confirm provider type and association with • Sign up for portal access: ePREP portal UnitedHealthcare Community Plan For more information, call the Maryland 4. Complete the ePREP application Department of Health Provider Enrollment 844-4MD-PROV ), ( 844-463-7768 HelpLine at Claims Processing Action Monday ‒ Friday, 7 a.m. ‒ 7 p.m., except state holidays. 1. List only registered National Provider Identifiers and care provider types on claims. You also can send an email to 2. Update service locations, telephone numbers and . [email protected] panel status in ePREP as changes occur. Care providers who don’t enroll, or whose information is out of date, may not be paid for services to Maryland HealthChoice recipients. The care provider’s network participation status may also be impacted as this lack of action is a breach of the UnitedHealthcare Provider Agreement. or visit 877-842-3210 45 | For more information, call UHCprovider.com .

46 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Community Plan Urgent Care Centers: Payment Policy Change for Codes S9083 and S9088 We’ve revised our UnitedHealthcare Community payment policies for urgent care services. Effective April 1, 2019, UnitedHealthcare Community Plan in Tennessee will no longer reimburse certain Healthcare Common Procedure Coding System (HCPCS) codes. These codes are informational and indicate the type of reimbursement and place of service. These codes do not adequately describe the specific service(s) provided. Unless otherwise noted, these reimbursement policies The affected HCPCS codes are: apply to services reported using the CMS-1500 or its Global Fee Urgent Care Center • S9083: electronic equivalent, or its successor form. Services provided in an urgent care center • S9088: UnitedHealthcare Community Plan reimbursement policies don’t address all issues related to reimbursement What You Need to Know for services rendered to our members, such as the Instead of billing S9083 or S9088, please bill the member’s benefit plan documents, our medical policies applicable CPT® codes for the evaluation and and the UnitedHealthcare Community Plan Administrative management and/or procedure services you performed. Guide or Care Provider Manual. Meeting the terms of a Also, please include a place of service code to report particular reimbursement policy is not a guarantee of where services were rendered. Charges for S9083 or payment. Likewise, retirement of a reimbursement policy S9088 billed on a claim will be denied. affects only those system edits associated with the specific policy being retired. Retirement of a reimbursement Reimbursement Policy policy is not a guarantee of payment. Other applicable reimbursement and medical policies and claims edits will The reimbursement policy for our Medicaid plans are continue to apply. posted on UHCprovider.com > Menu > Policies and Protocols > Community Plan Policies > Reimbursement If there’s an inconsistency or conflict between the Non-Covered Codes and Policies for Community Plan > information in this provider notification and the posted Covered Codes Policy, Professional — Reimbursement policy, the provisions of the posted reimbursement policy . They’re listed in alphabetical order. After accepting Policy prevail. If you have any questions, please contact your the Terms and Conditions to view the policy for your state, health plan representative or call the number on your scroll to the policy you need to view. Provider Remittance Advice/Explanation of Benefits. Note about Reimbursement Policies As with all UnitedHealthcare Community Plan policies, other factors affecting reimbursement may supplement, modify or in some cases supersede this policy. These factors include but are not limited to federal and/or state regulatory requirements, physician or other provider contracts, and/or the member’s benefit coverage documents. or visit 46 | For more information, call . UHCprovider.com 877-842-3210

47 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Community Plan UnitedHealthcare Community Plan Medical Policy, Medical Benefit Drug Policy and Coverage Determination Guideline Updates For complete details on the policy updates listed in the following table, please refer to the December 2018 Medical Policy Update Bulletin at UHCprovider.com > Policies and Protocols > Community Plan Policies > Medical & Drug Policies and . Coverage Determination Guidelines > Medical Policy Update Bulletins Policy Type Effective Date Policy Title TAKE NOTE Annual CPT® and HCPCS Code Updates UPDATED/REVISED Abnormal Uterine Bleeding and Uterine Fibroids Medical Feb. 1, 2019 Actemra® (Tocilizumab) Injection for Intravenous Infusion Drug Dec. 1, 2018 Medical Dec. 1, 2018 Athletic Pubalgia Surgery Feb. 1, 2019 Medical Attended Polysomnography for Evaluation of Sleep Disorders Balloon Sinus Ostial Dilation Feb. 1, 2019 Medical Botulinum Toxins A and B Drug Dec. 1, 2018 Bronchial Thermoplasty Medical Dec. 1, 2018 Carrier Testing for Genetic Diseases Medical Dec. 1, 2018 Dec. 1, 2018 Chemosensitivity and Chemoresistance Assays in Cancer Medical Computed Tomographic Colonography Medical Dec. 1, 2018 Medical Dec. 1, 2018 Computerized Dynamic Posturography Dec. 1, 2018 Core Decompression for Avascular Necrosis Medical Corneal Hysteresis and Intraocular Pressure Measurement Medical Dec. 1, 2018 Medical Cytological Examination of Breast Fluids for Cancer Screening Dec. 1, 2018 Discogenic Pain Treatment Medical Dec. 1, 2018 Electrical Bioimpedance for Cardiac Output Measurement Medical Dec. 1, 2018 CONTINUED > UHCprovider.com 47 | For more information, call 877-842-3210 or visit .

48 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Community Plan < CONTINUED UnitedHealthcare Community Plan Medical Policy, Medical Benefit Drug Policy and Coverage Determination Guideline Updates Effective Date Policy Title Policy Type UPDATED/REVISED Electrical Stimulation for the Treatment of Pain and Feb. 1, 2019 Medical Muscle Rehabilitation Embolization of the Ovarian and Iliac Veins for Pelvic Medical Dec. 1, 2018 Congestion Syndrome Entyvio® (Vedolizumab) Drug Dec. 1, 2018 Enzyme Replacement Therapy Dec. 1, 2018 Drug Epiduroscopy, Epidural Lysis of Adhesions and Functional Medical Dec. 1, 2018 Anesthetic Discography Femoroacetabular Impingement Syndrome Medical Feb. 1, 2019 Gastrointestinal Motility Disorders, Diagnosis and Treatment Medical Dec. 1, 2018 High Frequency Chest Wall Compression Devices Dec. 1, 2018 Medical Home Traction Therapy Medical Dec. 1, 2018 Infliximab (Remicade®, Inflectra™, Renflexis™) Drug Dec. 1, 2018 Intrauterine Fetal Surgery Dec. 1, 2018 Medical Laser Interstitial Thermal Therapy Dec. 1, 2018 Medical Light and Laser Therapy for Cutaneous Lesions and Pilonidal Disease Medical Dec. 1, 2018 Lithotripsy for Salivary Stones Medical Dec. 1, 2018 Medical Dec. 1, 2018 Motorized Spinal Traction Medical Dec. 1, 2018 Nerve Graft to Restore Erectile Function During Radical Prostatectomy Occipital Neuralgia and Headache Treatment Medical Feb. 1, 2019 Onpattro™ (Patisiran) Dec. 1, 2018 Drug Orencia® (Abatacept) Injection for Intravenous Infusion Drug Dec. 1, 2018 Plagiocephaly and Craniosynostosis Treatment Dec. 1, 2018 Medical Platelet Derived Growth Factors for Treatment of Wounds Medical Dec. 1, 2018 Preterm Labor Management Medical Dec. 1, 2018 Prolotherapy for Musculoskeletal Indications Medical Dec. 1, 2018 Sensory Integration Therapy and Auditory Integration Training Medical Dec. 1, 2018 CONTINUED > UHCprovider.com or visit 877-842-3210 48 | For more information, call .

49 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Community Plan < CONTINUED UnitedHealthcare Community Plan Medical Policy, Medical Benefit Drug Policy and Coverage Determination Guideline Updates Policy Type Policy Title Effective Date UPDATED/REVISED Drug Simponi Aria® (Golimumab) Injection for Intravenous Infusion Dec. 1, 2018 Thermography Dec. 1, 2018 Medical Dec. 1, 2018 Virtual Upper Gastrointestinal Endoscopy Medical Note: The inclusion of a health service (e.g., test, drug, device or procedure) on this list does not imply that UnitedHealthcare provides coverage for the health service. In the event of an inconsistency or conflict between the information in this bulletin and the posted policy, the provisions of the posted policy prevail. UHCprovider.com 49 | For more information, call 877-842-3210 or visit .

50 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Medicare Advantage Learn about Medicare policy and guideline changes. UnitedHealthcare Medicare Members Get Guidance on Advantage Policy Guideline Topics to Discuss with Care Updates Providers Beginning in December 2018, UnitedHealthcare members were UnitedHealthcare Medicare mailed pamphlets as a helpful Advantage Coverage guide on topics to discuss with Summary Updates their care providers as they make appointments in 2019. Your patients may bring this checklist to you during their next office visit. 877-842-3210 50 | For more information, call or visit UHCprovider.com .

51 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Medicare Advantage Members Get Guidance on Topics to Discuss with Care Providers As a UnitedHealthcare care provider, you provide a truly exceptional health care experience every step of the way. You provide personal guidance and solutions to help UnitedHealthcare members navigate the complexities of health care and make it easier for them to get the care, tests and treatment needed as quickly as possible. Beginning in December 2018, UnitedHealthcare members were mailed pamphlets as a helpful guide on topics to discuss with their care providers as they make appointments in 2019. Your interaction with your patients plays a key role in impacting their experience and overall health. Here is a sample of the topics guide that patients may bring to you: Talking with your doctor or care provider is important to your health. Use this checklist as a helpful guide on topics to discuss with your doctor or care provider at your next appointment. It can help you get the answers you need right away. PRESCRIPTION DRUGS GETTING NEEDED CARE Any questions with the prescription Concerns with getting the care, tests or medications you are taking treatments you need Scheduling routine care appointments Issues getting the medicines your provider prescribes in advance Ask your pharmacist/doctor if a Where and how to get urgent care 3-month supply of your maintenance when you need it right away medications would be right for you. Coordinating the care you are receiving from other doctors or specialists IMPORTANT CARE Difficulties getting appointments with a How to reduce the risk of falls specialist, if needed Issues related to bladder control and potential treatment options TESTS AND TREATMENTS When you will get results from labs, Suggestions on how to improve your X-rays or other tests physical activity You can also discuss the screenings Ways to improve feeling sad or blue mentioned on the front or any other health concerns. If you smoke or use tobacco, suggestions on how to quit smoking 1 This is a list of suggested screenings. Coverage for these screenings (including how often they are covered) may vary by plan. If you have questions about your specific benefits or coverage details, If you have any questions or need further information, contact your Network Provider Advocate. please call Customer Service at the number on the back of your member ID card or check your Evidence of Coverage. 2 American Cancer Society, 2018. All recommendations except mammogram are from the U.S. Preventive Services Task Force. Screenings may be more frequent depending on risk factors. Check with your doctor. . 51 | For more information, call 877-842-3210 or visit UHCprovider.com This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/ coinsurance may change on January 1 of each year. Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare. IR_SPRJ44807

52 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Medicare Advantage UnitedHealthcare Medicare Advantage Policy Guideline Updates The following UnitedHealthcare Medicare Advantage Policy Guidelines have been updated to reflect the most current clinical coverage rules and guidelines developed by the Centers for Medicare & Medicaid Services (CMS). The updated policies are UHCprovider.com > Menu > Policies and Protocols > available for your reference at . Medicare Advantage Policies > Policy Guidelines Policy Title NEW (Approved on Nov. 14, 2018) Prostate Rectal Spacers UPDATED/REVISED (Approved on Nov. 14, 2018) Cardiointegram (CIG) as an Alternative to Stress Test or Thallium Stress Test (NCD 20.27) Challenge Ingestion Food Testing (NCD 110.12) Chelation Therapy for Treatment of Atherosclerosis (NCD 20.21) Colony Stimulating Factors Diagnostic Endocardial Electrical Stimulation (Pacing) (NCD 20.12) Displacement Cardiography (NCD 20.24) Electrocardiographic Services (NCD 20.15) Epidural Injection Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions (NCD 110.21) Erythropoietin Stimulating Agent (ESA) Ethylenediamine-Tetra-Acetic (EDTA) Chelation Therapy for Treatment of Atherosclerosis (NCD 20.22) External Electrocardiographic Recording Hair Analysis (NCD 190.6) Hyperbaric Oxygen Therapy (NCD 20.29) Infrared Therapy Devices (NCD 270.6) Infusion Pumps (NCD 280.14) Intravenous Histamine Therapy (NCD 30.6) Lymphocyte Immune Globulin, Anti-Thymocyte Globulin (Equine) (NCD 260.7) CONTINUED > UHCprovider.com 52 | For more information, call 877-842-3210 or visit .

53 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Medicare Advantage < CONTINUED UnitedHealthcare Medicare Advantage Policy Guideline Updates Policy Title UPDATED/REVISED (Approved on Nov. 14, 2018) Peridex CAPD Filter Set (NCD 230.13) Plethysmography (NCD 20.14) Routine Costs in Clinical Trials (NCD 310.1) Screening for Hepatitis C Virus (HCV) in Adults (NCD 210.13) Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs (NCD 210.10) Services Provided for the Diagnosis and Treatment of Diabetic Sensory Neuropathy with Loss of Protective Sensation (aka Diabetic Peripheral Neuropathy) (NCD 70.2.1) Transfer Factor for Treatment of Multiple Sclerosis (NCD 160.20) Transportation Services Ultrafiltration Monitor (NCD 230.14) Ultrafiltration, Hemoperfusion and Hemofiltration (NCD 110.15) Vagus Nerve Stimulation (VNS) (NCD 160.18) RETIRED (Approved on Nov. 14, 2018) HIS Bundle Study (NCD 20.13) Note: The inclusion of a health service (e.g., test, drug, device or procedure) on this list does not imply that UnitedHealthcare provides coverage for the health service. In the event of an inconsistency or conflict between the information in this bulletin and the posted policy, the provisions of the posted policy prevail. 877-842-3210 . UHCprovider.com 53 | For more information, call or visit

54 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Medicare Advantage UnitedHealthcare Medicare Advantage Coverage Summary Updates For complete details on the policy updates listed in the following table, please refer to December 2018 Medicare Advantage Coverage Summary Update Bulletin the UHCprovider.com > Menu > Policies and Protocols > Medicare Advantage at Policies > Coverage Summaries > Coverage Summary Update Bulletins . Policy Title TAKE NOTE Annual CPT® and HCPCS Code Updates UPDATED/REVISED (Approved on Nov. 20, 2018) Cardiac Pacemakers and Defibrillators Family Planning (Birth Control) Foot Care Services Glaucoma Surgical Treatments Hearing Aids, Auditory Implants and Related Procedures Hyperbaric Oxygen Therapy Mobility Assistive Equipment (MAE) Ostomy Supplies Positron Emission Tomography (PET)/Combined PET-CT (Computed Tomography) Radiologic Therapeutic Procedures Services While Confined/Incarcerated Spine Procedures Vertebral Artery Surgery Note: The inclusion of a health service (e.g., test, drug, device or procedure) on this list does not imply that UnitedHealthcare provides coverage for the health service. In the event of an inconsistency or conflict between the information in this bulletin and the posted policy, the provisions of the posted policy prevail. UHCprovider.com 54 | For more information, call 877-842-3210 or visit .

55 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Affiliates Learn about updates with our company partners. UnitedHealthcare West Reminder for Your Patients Medical Management in UnitedHealthcare Oxford Commercial Plans Guideline Updates In December 2017, we let care providers know that we would UnitedHealthcare West be taking steps to streamline Benefit Interpretation the administrative experience Policy for UnitedHealthcare Oxford commercial plans. These steps have begun and will continue over the next 24 to 36 months as Oxford® Medical and employer groups renew health Administrative Policy coverage for their employees Updates 877-842-3210 55 | For more information, call . UHCprovider.com or visit

56 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Affiliates Oxford® Medical and Administrative Policy Updates For complete details on the policy updates listed in the following table, please refer to December 2018 Policy Update Bulletin the OxfordHealth.com > Providers > at Tools & Resources > Medical Information > Medical and Administrative Policies > Policy Update Bulletin . Policy Title Policy Type Effective Date TAKE NOTE Annual CPT® and HCPCS Code Updates NEW Clinical Jan. 1, 2019 Negative Pressure Wound Therapy Jan. 1, 2019 Administrative Par Surgeons Using Non-Par Assistant Surgeons and Co-Surgeons UPDATED/REVISED Clinical Dec. 1, 2018 17-Alpha-Hydroxyprogesterone Caproate (Makena™ and 17P) Clinical Ablative Treatment for Spinal Pain Jan. 1, 2019 Athletic Pubalgia Surgery Clinical Dec. 1, 2018 Clinical Dec. 1, 2018 Attended Polysomnography for Evaluation of Sleep Disorders Dec. 1, 2018 Clinical Autologous Chondrocyte Transplantation in the Knee Clinical Balloon Sinus Ostial Dilation Dec. 1, 2018 Behavioral Health Services Administrative Jan. 1, 2019 Botulinum Toxins A and B Clinical Dec. 1, 2018 Breast Reconstruction Post Mastectomy Clinical Dec. 1, 2018 Breast Repair/Reconstruction Not Following Mastectomy Clinical Dec. 1, 2018 Bronchial Thermoplasty Clinical Dec. 1, 2018 Clinical Dec. 1, 2018 Chemosensitivity and Chemoresistance Assays in Cancer Computerized Dynamic Posturography Clinical Dec. 1, 2018 Dec. 1, 2018 Clinical Core Decompression for Avascular Necrosis Corneal Hysteresis and Intraocular Pressure Measurement Clinical Dec. 1, 2018 CONTINUED > . UHCprovider.com or visit 877-842-3210 56 | For more information, call

57 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Affiliates < CONTINUED Oxford® Medical and Administrative Policy Updates Policy Title Policy Type Effective Date UPDATED/REVISED Clinical Dec. 1, 2018 Cytological Examination of Breast Fluids for Cancer Screening Clinical Dec. 1, 2018 Dental and Oral Surgical Procedures Discogenic Pain Treatment Clinical Dec. 1, 2018 Drug Coverage Criteria - New and Therapeutic Equivalent Medications Clinical Jan. 1, 2019 Drug Coverage Guidelines Clinical Dec. 1, 2018 Drug Coverage Guidelines Clinical Jan. 1, 2019 Clinical Dec. 1, 2018 Electrical Bioimpedance for Cardiac Output Measurement Electrical Stimulation for the Treatment of Pain and Clinical Jan. 1, 2019 Muscle Rehabilitation Embolization of the Ovarian and Iliac Veins for Clinical Dec. 1, 2018 Pelvic Congestion Syndrome Enzyme Replacement Therapy Clinical Dec. 1, 2018 Enzyme Replacement Therapy Clinical March 1, 2019 Epiduroscopy, Epidural Lysis of Adhesions and Clinical Dec. 1, 2018 Functional Anesthetic Discography Clinical Jan. 1, 2019 Femoroacetabular Impingement Syndrome Treatment Fetal Aneuploidy Testing Using Cell-Free Fetal Nucleic Acids Clinical Dec. 1, 2018 in Maternal Blood Formula & Specialized Food Administrative Jan. 1, 2019 Gastrointestinal Motility Disorders, Diagnosis and Treatment Clinical Dec. 1, 2018 Genetic Testing for Hereditary Cancer Clinical Jan. 1, 2019 Hearing Aids and Devices Including Wearable, Bone-Anchored Clinical Jan. 1, 2019 and Semi-Implantable Clinical Dec. 1, 2018 High Frequency Chest Wall Compression Devices Hip Resurfacing and Replacement Surgery (Arthroplasty) Clinical Dec. 1, 2018 Home Traction Therapy Clinical Dec. 1, 2018 Implanted Electrical Stimulator for Spinal Cord Clinical Jan. 1, 2019 Injectable Chemotherapy Drugs: Application of NCCN Clinical Clinical Jan. 1, 2019 Practice Guidelines Dec. 1, 2018 Intrauterine Fetal Surgery Clinical CONTINUED > UHCprovider.com or visit 877-842-3210 57 | For more information, call .

58 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Affiliates < CONTINUED Oxford® Medical and Administrative Policy Updates Policy Title Policy Type Effective Date UPDATED/REVISED Clinical Dec. 1, 2018 Laser Interstitial Thermal Therapy Clinical Dec. 1, 2018 Light and Laser Therapy for Cutaneous Lesions and Pilonidal Disease Lithotripsy for Salivary Stones Clinical Dec. 1, 2018 Molecular Oncology Testing for Cancer Diagnosis, Prognosis, Jan. 1, 2019 Clinical and Treatment Decisions Clinical Dec. 1, 2018 Motorized Spinal Traction Nerve Graft to Restore Erectile Function During Radical Prostatectomy Clinical Dec. 1, 2018 Neurophysiologic Testing and Monitoring Clinical Jan. 1, 2019 Obstructive Sleep Apnea Treatment Clinical Jan. 1, 2019 Office Based Program Clinical Dec. 1, 2018 Omnibus Codes Clinical Jan. 1, 2019 Onpattro™ (Patisiran) Clinical Jan. 1, 2019 Clinical Dec. 1, 2018 Orencia® (Abatacept) Injection for Intravenous Infusion Oxford's Outpatient Imaging Self-Referral Jan. 1, 2019 Clinical Plagiocephaly and Craniosynostosis Treatment Clinical Dec. 1, 2018 Platelet Derived Growth Factors for Treatment of Wounds Clinical Dec. 1, 2018 Preterm Labor Management Clinical Dec. 1, 2018 Preventive Care Services Clinical Jan. 1, 2019 Prolotherapy for Musculoskeletal Indications Clinical Dec. 1, 2018 Radicava™ (Edaravone) Clinical Dec. 1, 2018 Rituxan® (Rituximab) Dec. 1, 2018 Clinical Sandostatin LAR® Depot (Octreotide Acetate) Dec. 1, 2018 Clinical Sensory Integration Therapy and Auditory Integration Training Clinical Dec. 1, 2018 Simponi Aria® (Golimumab) Injection for Intravenous Infusion Clinical Dec. 1, 2018 Skin and Soft Tissue Substitutes Clinical Dec. 1, 2018 Sodium Hyaluronate Clinical Jan. 1, 2019 Specialty Medication Administration - Site of Care Review Guidelines Clinical Jan. 1, 2019 Dec. 1, 2018 Synagis® (Palivizumab) Clinical CONTINUED > UHCprovider.com or visit 877-842-3210 58 | For more information, call .

59 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Affiliates < CONTINUED Oxford® Medical and Administrative Policy Updates Effective Date Policy Title Policy Type UPDATED/REVISED Clinical Thermography Dec. 1, 2018 Dec. 1, 2018 Virtual Upper Gastrointestinal Endoscopy Clinical Whole Exome and Whole Genome Sequencing Clinical Jan. 1, 2019 Xolair® (Omalizumab) Clinical Dec. 1, 2018 The inclusion of a health service (e.g., test, drug, device or procedure) on this list does not imply that Oxford Note: provides coverage for the health service. In the event of an inconsistency or conflict between the information in this bulletin and the posted policy, the provisions of the posted policy prevail. Oxford HMO products are underwritten by Oxford Health Plans (NJ), Inc. and Oxford Health Plans (CT), Inc. Oxford insurance products are underwritten by Oxford Health Insurance, Inc. UHCprovider.com 59 | For more information, call 877-842-3210 or visit .

60 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Affiliates Reminder for Your Patients in UnitedHealthcare Oxford Commercial Plans In December 2017, we let care providers know that we would be taking steps to streamline the administrative experience for UnitedHealthcare Oxford commercial plans. These steps have begun and will continue over the next 24 to 36 months as employer groups renew health coverage for their employees. If you have patients whose employers are renewing their When your patients see you for care, ask health coverage with a UnitedHealthcare Oxford commercial your staff to: plan, you’ll see some differences in their new member • Check their eligibility each time they visit your office. identification (ID) card that we want to remind you about: • Include their new member ID number on claims or digits • The member’s ID number will be 11 requests for services that require authorization. numeric-only . • The Group Number will change to be • Use the provider website listed on the back of the • The website listed on the back of the card is member’s ID card for secure transactions. . UHCprovider.com Quick For more information about these changes, use this The ERA Payer ID number will not change and will remain and share it with your staff. Reference Guide 06111 . For more information, please call Provider Services at 800-666-1353 . When you call, provide your National Provider Identifier (NPI) number. 60 | For more information, call or visit . UHCprovider.com 877-842-3210

61 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Affiliates UnitedHealthcare West Medical Management Guideline Updates For complete details on the policy updates listed in the following table, please refer to the December 2018 UnitedHealthcare West Medical Management Guidelines UHCprovider.com > Policies and Protocols > Commercial at Update Bulletin Policies > UnitedHealthcare West Medical Management Guidelines > Medical Management Guideline Update Bulletins . Policy Title Effective Date TAKE NOTE Annual CPT® and HCPCS Code Updates UPDATED/REVISED Jan. 1, 2019 Abnormal Uterine Bleeding and Uterine Fibroids Athletic Pubalgia Surgery Dec. 1, 2018 Attended Polysomnography for Evaluation of Sleep Disorders Jan. 1, 2019 Balloon Sinus Ostial Dilation Jan. 1, 2019 Breast Repair/Reconstruction Not Following Mastectomy Dec. 1, 2018 Bronchial Thermoplasty Dec. 1, 2018 Chemosensitivity and Chemoresistance Assays in Cancer Dec. 1, 2018 Dec. 1, 2018 Clinical Trials Computed Tomographic Colonography Dec. 1, 2018 Computerized Dynamic Posturography Dec. 1, 2018 Dec. 1, 2018 Core Decompression for Avascular Necrosis Corneal Hysteresis and Intraocular Pressure Measurement Dec. 1, 2018 Dec. 1, 2018 Cytological Examination of Breast Fluids for Cancer Screening Discogenic Pain Treatment Dec. 1, 2018 Electrical Bioimpedance for Cardiac Output Measurement Dec. 1, 2018 Jan. 1, 2019 Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation CONTINUED > UHCprovider.com 61 | For more information, call 877-842-3210 or visit .

62 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Affiliates < CONTINUED UnitedHealthcare West Medical Management Guideline Updates Policy Title Effective Date UPDATED/REVISED Embolization of the Ovarian and Iliac Veins for Pelvic Congestion Syndrome Dec. 1, 2018 Epiduroscopy, Epidural Lysis of Adhesions and Functional Anesthetic Discography Dec. 1, 2018 Femoroacetabular Impingement Syndrome Jan. 1, 2019 Gastrointestinal Motility Disorders, Diagnosis and Treatment Dec. 1, 2018 High Frequency Chest Wall Compression Devices Dec. 1, 2018 Home Traction Therapy Dec. 1, 2018 Intensive Behavioral Therapy for Autism Spectrum Disorder Dec. 1, 2018 Intrauterine Fetal Surgery Dec. 1, 2018 Laser Interstitial Thermal Therapy Dec. 1, 2018 Light and Laser Therapy for Cutaneous Lesions and Pilonidal Disease Dec. 1, 2018 Lithotripsy for Salivary Stones Dec. 1, 2018 Minimally Invasive Procedures for Gastroesophogeal Reflux Disease (GERD) Dec. 1, 2018 Molecular Oncology Testing for Cancer Diagnosis, Prognosis, and Treatment Decisions Jan. 1, 2019 Motorized Spinal Traction Dec. 1, 2018 Nerve Graft to Restore Erectile Function During Radical Prostatectomy Dec. 1, 2018 Neurophysiologic Testing and Monitoring Jan. 1, 2019 Occipital Neuralgia and Headache Treatment Jan. 1, 2019 Plagiocephaly and Craniosynostosis Treatment Dec. 1, 2018 Platelet Derived Growth Factors for Treatment of Wounds Dec. 1, 2018 Dec. 1, 2018 Preterm Labor Management Jan. 1, 2019 Preventive Care Services Prolotherapy for Musculoskeletal Indications Dec. 1, 2018 Dec. 1, 2018 Sensory Integration Therapy and Auditory Integration Training Specialty Medication Administration – Site of Care Review Guidelines Jan. 1, 2019 Thermography Dec. 1, 2018 Dec. 1, 2018 Virtual Upper Gastrointestinal Endoscopy CONTINUED > UHCprovider.com or visit 877-842-3210 62 | For more information, call .

63 UnitedHealthcare Network Bulletin Table of Contents January 2019 UnitedHealthcare Affiliates < CONTINUED UnitedHealthcare West Medical Management Guideline Updates Policy Title Effective Date UPDATED/REVISED Visual Information Processing Evaluation and Orthoptic and Vision Therapy Dec. 1, 2018 Warming Therapy and Ultrasound Therapy for Wounds Dec. 1, 2018 Whole Exome and Whole Genome Sequencing Jan. 1, 2019 The inclusion of a health service (e.g., test, drug, device or procedure) on this list does not imply that Note: UnitedHealthcare provides coverage for the health service. In the event of an inconsistency or conflict between the information in this bulletin and the posted policy, the provisions of the posted policy prevail. UHCprovider.com 63 | For more information, call 877-842-3210 or visit .

64 UnitedHealthcare Network Bulletin January 2019 Table of Contents UnitedHealthcare Affiliates UnitedHealthcare West Benefit Interpretation Policy Updates For complete details on the policy updates listed in the following table, please refer to December 2018 UnitedHealthcare West Benefit Interpretation Policy Update the UHCprovider.com > Policies and Protocols > Commercial Policies > at Bulletin UnitedHealthcare West Benefit Interpretation Policies > Benefit Interpretation Policy Update Bulletins . Applicable State(s) Policy Title UPDATED/REVISED (Effective Jan. 1, 2019) All (California, Oklahoma, Oregon, Texas, Cosmetic, Reconstructive, or Plastic Surgery & Washington) Oklahoma, Oregon, Texas, & Washington Family Planning: Birth Control All Habilitative Services All Member Initiated Second and Third Opinion Pain Management All Pervasive Developmental Disorder and Autism All Spectrum Disorder Telemedicine/Telehealth Services/Virtual Visits All The inclusion of a health service (e.g., test, drug, device or procedure) on this list does not imply that Note: UnitedHealthcare provides coverage for the health service. In the event of an inconsistency or conflict between the information in this bulletin and the posted policy, the provisions of the posted policy prevail. . UHCprovider.com or visit 877-842-3210 64 | For more information, call

65 January 2019 UnitedHealthcare Network Bulletin Table of Contents State News Stay up to date with the latest state/regional news. Appointment Standards for Reminder on the State of Connecticut Reimbursement for Maternity Services in New UnitedHealthcare’s network care Jersey providers play an essential role in helping ensure members have Pursuant to the State of New appropriate access to primary, Jersey Department of Banking urgent, preventive and specialty and Insurance regulation N.J.A.C. care. To help ensure timely member 11:22-9, New Jersey licensed access to care, the State of obstetrical providers can elect Appointment Standards for Connecticut requires compliance to receive reimbursement for with appointment standards. the State of Maryland maternity services either globally or in installments. If you’d like to The care providers who are receive your payments for maternity contracted with UnitedHealthcare services in installments, complete play an essential role in helping and return the Maternity Installment our plan members get the primary, Payments Election Form by Jan. 31, urgent, preventive and specialty 2019. care they need, at the moment they need it. To help ensure our plan members have timely access to care, the State of Maryland requires carriers’ compliance with appointment standards. . 65 | For more information, call or visit 877-842-3210 UHCprovider.com

66 UnitedHealthcare Network Bulletin January 2019 Table of Contents State News Appointment Standards for the State of Maryland The care providers who are contracted with UnitedHealthcare play an essential role in helping our plan members get the primary, urgent, preventive and specialty care they need, at the moment they need it. To help ensure our plan members have timely access to care, the State of Maryland requires carriers’ compliance with the following appointment standards: Type of Service Standard Urgent care – including medical, behavioral Within 72 hours of the member contacting the care provider health and substance use disorder services Routine primary care Within 15 calendar days of the member contacting the care provider Within 30 calendar days of the member contacting the care provider Preventive visit/well visit Within 30 calendar days of the member contacting the care provider Non-urgent specialty care Non-urgent behavioral health/substance Within 10 calendar days of the member contacting the care provider use disorder services If you have questions, please contact Provider . Relations at [email protected] 66 | For more information, call 877-842-3210 or visit . UHCprovider.com

67 UnitedHealthcare Network Bulletin Table of Contents January 2019 State News Reminder on Reimbursement for Maternity Services in New Jersey Pursuant to the State of New Jersey Department of Banking and Insurance regulation N.J.A.C. 11:22-9, New Jersey licensed obstetrical providers can elect to receive reimbursement for maternity services either globally or in installments. If you’d like to receive your payments for maternity services in installments, please complete and return the Maternity Installment Payments Election Form by Jan. 31, 2019. If you don’t want to change your current reimbursement arrangement, no action by you is required. UHCprovider.com/ For more information, go to en/health-plans-by-state/new-jersey-health- . plans/nj-commercial-plans.html UHCprovider.com 67 | For more information, call 877-842-3210 or visit .

68 UnitedHealthcare Network Bulletin January 2019 Table of Contents State News Appointment Standards for the State of Connecticut UnitedHealthcare’s network care providers play an essential role in helping ensure members have appropriate access to primary, urgent, preventive and specialty care. To that end, we have established standards for appointment access and after-hours care, which you can find in the UnitedHealthcare Care Provider Administrative Guide at > Menu > Administrative Guides. UHCprovider.com To help ensure timely member access to care, the State of Connecticut requires compliance with the following appointment standards: Type of Service Standard Within 48 hours of the member contacting the care provider Urgent care Within 10 business days of the member contacting the care provider Non-urgent appointments for primary care Within 15 business days of the member contacting the care provider Non-urgent appointments for specialist care Within 10 business days of the member contacting the care provider Non-urgent for non-physical mental health Within 15 business days of the member contacting the care provider Non-urgent for ancillary services This protocol is available at UHCprovider.com > Menu > Policies and Protocols > Protocols > Appointment Standards for the State of Connecticut . 877-842-3210 or visit UHCprovider.com 68 | For more information, call .

69 UnitedHealthcare Network Bulletin Table of Contents January 2019 Insurance coverage provided by or through UnitedHealthcare Insurance Company, All Savers Insurance Company or its affiliates. Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Texas, Inc., UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc. and UnitedHealthcare of Washington, Inc. or other affiliates. Administrative services provided by United HealthCare Services, Inc. OptumRx, OptumHealth Care Solutions, Inc. or its affiliates. Behavioral health products are provided by U.S. Behavioral Health Plan, California (USBHPC), United Behavioral Health (UBH) or its affiliates. Doc#: PCA-1-013190-12042018_12112018 CPT® is a registered trademark of the American Medical Association © 2018 United HealthCare Services, Inc. or visit 69 | For more information, call . UHCprovider.com 877-842-3210

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STATE OF NEW YORK 2 0 1 9 T E N T A T I V E A S S E S S M E N T R O L L PAGE 1 VALUATION DATE-JUL 01, 2018 COUNTY - Niagara T A X A B L E SECTION OF THE ROLL - 1 CITY - North Tonawanda TAX MAP NUMBER ...

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G:\COMP\PHSA\PHSA.bel

G:\COMP\PHSA\PHSA.bel

G:\COMP\PHSA\PHSA-MERGED.XML PUBLIC HEALTH SERVICE ACT [As Amended Through P.L. 115–408, Enacted December 31, 2018] References in brackets ¿ ø¿ ø are to title 42, United States Code TITLE I—SHORT TITL...

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CRPT 116hrpt9 u2

U:\2019CONF\HJRes31Front.xml APPRO. SEN. [COMMITTEE PRINT] REPORT { } CONGRESS 116TH 1st HOUSE OF REPRESENTATIVES Session 116- FURTHER APPROPRIATIONS FOR MAKING CONTINUING OF HOMELAND SECURITY FOR THE...

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UNCLASSIFIED Department of Defense Fiscal Year (FY) 2019 Budget Estimates February 2018 Office of the Secretary Of Defense Defense-Wide Justification Book Volume 3B of 5 Research, Development, Test & ...

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John Bel Edwards Rebekah E. Gee MD, MPH SECRETARY GOVERNOR State of Louisiana Louisiana Department of Health Office of Public Health Certified Water and Wastewater Operators 2018 - 2019 Hours Hours li...

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OctoberCUR2018

OctoberCUR2018

CHANCELLOR'S UNIVERSITY REPORT OCTOBER 29 2018

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Untitled

Untitled

Harmoniz ed vision 4 hedule of the United States (2019) Re Tariff Sc Annotated f poses ting Pur or Statistical Repor GN p .1 GENERAL R ATION ULES OF INTERPRET inciples: wing pr ollo y the f verned b i...

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untitled

untitled

G:\P\16\HR1\INTRO.XML ... (Original Signature of Member) TH 116 CONGRESS 1 ST S ESSION H. R. 1 To expand Americans’ access to the ballot box, reduce the influence of big money in politics, and strengt...

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NB18

NB18

Table of Contents National Board Pressure Relief Device Certificati ons NB-18 FOREWARD... 1 NATIONAL BOARD PRESSURE RELIEF DEVICE CERTIFICATION... 2 DETERMINATION OF CERTIFIED RELIEVING CAPACITIES... ...

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June2018CUR

June2018CUR

CHANCELLOR'S UNIVERSITY REPORT JUNE 25 2018

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City 2018 2019

City 2018 2019

2018–2019 CATALOG Fall 2018, Spring 2019, Summer 2019 1313 Park Blvd., San Diego, CA 92101 619-388-3400 www.sdcity.edu Ricky Shabazz, Ed.D. President San Diego City College is accredited by the Accred...

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OPERATOR'S DIRECTORY SORTED BY OPERATOR NAME DATA SUPPLIED BY: FORM 1006 B CURRENT AS OF: Tuesday, April 16, 2019 Please notify Surety Department at ( 405 ) 521-2273 of any corrections or omissions th...

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G:\COMP\SBA\SBA.bel

G:\COMP\SBA\SMALL BUSINESS ACT.XML SMALL BUSINESS ACT [Public Law 85–536; Approved July 18, 1958] [15 U.S.C. 631 et seq.; 72 Stat. 384 et seq.] [As Amended Through P.L. 115-416, Enacted January 3, 201...

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DEC CUR

DEC CUR

CHANCELLOR'S UNIVERSITY REPORT DECEMBER 10, 2018

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Nios® II Software Developer's Handbook

Nios® II Software Developer's Handbook

® Nios II Software Developer's Handbook ® ® Quartus Updated for Intel Prime Design Suite: 19.1 Subscribe NII-SDH | 2019.04.30 Send Feedback Latest document on the web: PDF | HTML

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