05/01/2023

Oxford Denials for RFC Stating Pre-Auth is Needed for 11056 and 11721

We recently received denials from Oxford for Routine Foot Care in which Oxford Stated the patients are required to obtain a pre authorization from their Primary Care Physician for the codes 11056 and 11721. The representative stated that this is the policy as of 1/1/2023. The same claims were submitted and paid in 2022. Do you have any information on this new policy?

It has been brought to our attention by several doctors that they have been receiving denials from UnitedHealthCare Oxford for missing prior auth for RFC codes. Please note that these denials reflect the prior-auth requirement that went into effect January 01, 2023. As of January, 01 2023, the codes below require prior authorization for all healthcare professionals who participate in inpatient and outpatient services with Oxford Commercial Plans:

Foot Surgery	Prior Auth Req	28285	28289	28291	28292
		28296	28297	28298	28299
RFC	Prior Auth Req	11055	11719	11720	11721