Last Published 04.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 04.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 04.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 04.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 04.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 04.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 04.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 04.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 01.01.2024
The complete library of UnitedHealthcare Individual & Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 05.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 05.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 05.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 05.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 02.01.2024
The complete library of UnitedHealthcare Individual and Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 06.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 06.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 06.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 06.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 03.01.2023
The complete library of UnitedHealthcare Individual & Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 03.01.2024
The complete library of UnitedHealthcare Individual and Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 07.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 07.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 07.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 07.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 04.01.2023
The complete library of UnitedHealthcare Individual & Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 04.01.2024
The complete library of UnitedHealthcare Individual and Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 08.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 08.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 08.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 08.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 08.18.2023
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 05.01.2023
The complete library of UnitedHealthcare Individual & Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Oxford Clinical and/or Administrative Policies.
Last Published 05.13.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan Medical Policies and/or Medical Benefit Drug Policies.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan of Indiana Medical Policies and/or Medical Benefit Drug Policies.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan of Kentucky Medical Policies and/or Medical Benefit Drug Policies.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan of Louisiana Medical Policies and/or Medical Benefit Drug Policies.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan of North Carolina Medical Policies.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan of Ohio Medical Policies and/or Medical Benefit Drug Policies.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan of Pennsylvania Medical Policies and/or Medical Benefit Drug Policies.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan of Tennessee Medical Policies and/or Medical Benefit Drug Policies.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Dental Clinical Policies, Coverage Guidelines, and Utilization Review Guidelines.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UMR Medical Policies and/or Medical Benefit Drug Policies.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare West Benefit Interpretation Policies.
Last Published 05.13.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Commercial Medical Policies and/or Medical Benefit Drug Policies.
Last Published 05.01.2024
The complete library of UnitedHealthcare Individual and Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 05.13.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Individual Exchange Medical Policies and/or Medical Benefit Drug Policies.
Last Published 05.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare West Medical Management Guidelines.
Last Published 09.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 09.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 09.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 08.18.2023
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Oxford Clinical and/or Administrative Policies.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan of Indiana Medical Policies and/or Medical Benefit Drug Policies.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan of Kentucky Medical Policies and/or Medical Benefit Drug Policies.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan of Louisiana Medical Policies and/or Medical Benefit Drug Policies.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan of Ohio Medical Policies and/or Medical Benefit Drug Policies.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan of Tennessee Medical Policies and/or Medical Benefit Drug Policies.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Dental Clinical Policies, Coverage Guidelines, and Utilization Review Guidelines.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Medical Policies, Coverage Summaries and/or Policy Guidelines.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Medical Policies, Coverage Summaries and/or Policy Guidelines.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UMR Medical Policies and/or Medical Benefit Drug Policies.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare West Benefit Interpretation Policies.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Commercial Medical Policies and/or Medical Benefit Drug Policies.
Last Published 06.01.2024
The complete library of UnitedHealthcare Individual and Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Commercial Medical Policies and/or Medical Benefit Drug Policies.
Last Published 06.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare West Medical Management Guidelines.
Last Published 10.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 10.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 08.18.2023
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 10.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare West Medical Management Guidelines.
Last Published 11.01.2022
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 11.01.2022
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 11.01.2022
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 11.01.2022
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 11.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 11.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 11.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 11.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 08.24.2023
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 08.01.2023
The complete library of UnitedHealthcare Individual & Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 12.01.2022
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 12.01.2022
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 12.01.2022
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 12.01.2022
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 09.01.2022
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 12.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 12.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 12.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 12.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 09.01.2023
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 09.01.2023
The complete library of UnitedHealthcare Individual & Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 01.01.2024
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 01.26.2023
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 01.01.2024
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 03.01.2022
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Community Plan of Tennessee Medical Policies, Medical Benefit Drug Policies, Coverage Determination Guidelines (CDG), and/or Utilization Review Guidelines (URG).
Last Published 01.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 01.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 01.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 01.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 10.01.2022
The complete library of UnitedHealthcare Individual & Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 01.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 01.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 01.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 01.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 10.01.2022
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 02.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 02.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 02.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 02.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 11.01.2022
The complete library of UnitedHealthcare Individual & Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 02.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 02.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 02.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 02.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 11.01.2023
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 11.01.2023
The complete library of UnitedHealthcare Individual & Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 11.01.2022
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 11.01.2023
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 06.24.2019
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Commercial Medical Policies, Medical Benefit Drug Policies, Coverage Determination Guidelines (CDG), Utilization Review Guidelines (URG), and/or Quality of Care Guidelines (QOCG).
Last Published 02.26.2018
Last Published 03.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 03.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 03.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 03.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 12.01.2022
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 12.01.2022
The complete library of UnitedHealthcare Individual & Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 03.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 03.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 03.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 03.01.2024
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 12.01.2023
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 12.01.2023
The complete library of UnitedHealthcare Individual & Family Plan Reimbursement Policies is available at UHCprovider.com > Policies and Protocols > Exchange-Policies > Exchanges-Reimbursement-Policies.
Last Published 12.01.2022
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 02.01.2024
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 02.24.2023
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 02.01.2024
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 03.01.2023
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 03.01.2024
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 03.01.2023
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 03.01.2024
UnitedHealthcare Commercial monthly reimbursement policy updates.
Last Published 08.18.2023
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 04.01.2024
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 05.23.2023
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 04.01.2024
UnitedHealthcare Commercial monthly reimbursement policy updates.
Last Published 05.24.2024
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 05.23.2023
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 05.01.2024
UnitedHealthcare Commercial monthly reimbursement policy updates.
Last Published 06.01.2023
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 06.01.2024
UnitedHealthcare Commercial monthly reimbursement policy updates.
Last Published 07.01.2023
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 08.01.2022
Published reimbursement policies are intended to ensure reimbursement based on the code or codes that correctly describe the health care services provided.
Last Published 08.01.2023
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 09.01.2023
UnitedHealthcare Commercial monthly reimbursement policy updates
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses intraosseous radiofrequency ablation, ablation for treating sacroiliac pain, and other facet joint nerve ablation procedures for spinal pain. Applicable Procedure Codes: 22899, 27299, 64625, 64628, 64629, 64999.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses intraosseous radiofrequency ablation, ablation for treating sacroiliac pain, and other facet joint nerve ablation procedures for spinal pain. Applicable Procedure Codes: 22899, 27299, 64625, 64628, 64629, 64999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses intraosseous radiofrequency ablation, ablation for treating sacroiliac pain, and other facet joint nerve ablation procedures for spinal pain. Applicable Procedure Codes: 22899, 27299, 64625, 64628, 64629, 64999.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses thermal radiofrequency ablation and other facet joint nerve ablation procedures for spinal pain. Applicable Procedure Codes: 22899, 27299, 64625, 64628, 64629, 64999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses intraosseous radiofrequency ablation, ablation for treating sacroiliac pain, and other facet joint nerve ablation procedures for spinal pain. Applicable Procedure Codes: 22899, 27299, 64625, 64628, 64629, 64999.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses thermal radiofrequency ablation and other facet joint nerve ablation procedures for spinal pain. Applicable Procedure Codes: 22899, 27299, 64625, 64628, 64629, 64999.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses thermal radiofrequency ablation and other facet joint nerve ablation procedures for spinal pain. Applicable Procedure Codes: 22899, 27299, 64625, 64628, 64629, 64999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses intraosseous radiofrequency ablation, ablation for treating sacroiliac pain, and other facet joint nerve ablation procedures for spinal pain. Applicable Procedure Codes: 22899, 27299, 64625, 64628, 64629, 64999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses intraosseous radiofrequency ablation, ablation for treating sacroiliac pain, and other facet joint nerve ablation procedures for spinal pain. Applicable Procedure Codes: 22899, 27299, 64625, 64628, 64629, 64999.
Last Published 02.01.2024
Effective Date: 01.01.2024 – This policy addresses Intraosseous radiofrequency ablation, ablation for treating sacroiliac pain, and other facet joint nerve ablation procedures for spinal pain. Applicable Procedure Codes: 22899, 27299, 64625, 64628, 64629,
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses conventional thermal radiofrequency ablation and other facet joint nerve ablation procedures for spinal pain. Applicable Procedure Codes: 22899, 27299, 64625, 64628, 64629, 64999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses conventional thermal radiofrequency ablation and other facet joint nerve ablation procedures for spinal pain. Applicable Procedure Codes: 22899, 27299, 64625, 64628, 64629, 64999.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of levonorgestrel-releasing intrauterine devices (LNG-IUD), uterine artery embolization (UAE), magnetic resonance-guided focused ultrasound ablation (MRgFUS), and ultrasound-guided radiofrequency ablation. Applicable Procedure Codes: 0071T, 0072T, 37243, 58563, J7296, J7297, J7298, J7301, J7306, S4981.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of levonorgestrel-releasing intrauterine devices (LNG-IUD), uterine artery embolization (UAE), magnetic resonance-guided focused ultrasound ablation (MRgFUS), and ultrasound-guided radiofrequency ablation. Applicable Procedure Codes: 0071T, 0072T, 37243, 58563, J7296, J7297, J7298, J7301, J7306, S4981.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of levonorgestrel-releasing intrauterine devices (LNG-IUD), uterine artery embolization (UAE), magnetic resonance-guided focused ultrasound ablation (MRgFUS), and ultrasound-guided radiofrequency ablation. Applicable Procedure Codes: 0071T, 0072T, 0404T, 37243, 58673. 58674, J7296, J7297, J7298, J7301, J7306, S4981.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the endometrial ablation, the use of levonorgestrel-releasing intrauterine devices (LNG-IUDs), uterine artery embolization (UAE), and magnetic resonance-guided focused ultrasound ablation (MRgFUS). Applicable Procedure Codes: 0071T, 0072T, 37243, 58563, J7296, J7297, J7298, J7301, J7306, S4981.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of levonorgestrel-releasing intrauterine devices (LNG-IUD), uterine artery embolization (UAE), magnetic resonance-guided focused ultrasound ablation (MRgFUS), and ultrasound-guided radiofrequency ablation. Applicable Procedure Codes: 0071T, 0072T, 37243, 58563, J7296, J7297, J7298, J7301, J7306, S4981.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of levonorgestrel-releasing intrauterine devices (LNG-IUD), uterine artery embolization (UAE), magnetic resonance-guided focused ultrasound ablation (MRgFUS), and ultrasound-guided radiofrequency ablation. Applicable Procedure Codes: 0071T, 0072T, 37243, 58563, J7296, J7297, J7298, J7301, J7306, S4981.
Last Published 01.01.2024
Effective Date: 11.01.2023 – This policy addresses endometrial ablation, the use of levonorgestrel-releasing intrauterine devices (LNG-IUD), uterine artery embolization (UAE), magnetic resonance-guided focused ultrasound ablation (MRgFUS), and ultrasound-guided radiofrequency ablation. Applicable Procedure Codes: 0071T, 0072T, 37243, 58563, J7296, J7297, J7298, J7301, J7306, S4981.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of levonorgestrel-releasing intrauterine devices (LNG-IUD), uterine artery embolization (UAE), magnetic resonance-guided focused ultrasound ablation (MRgFUS), and ultrasound-guided radiofrequency ablation. Applicable Procedure Codes: 0071T, 0072T, 37243, J7296, J7297, J7298, J7301, J7306, S4981.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses endometrial ablation, the use of levonorgestrel-releasing intrauterine devices (LNG-IUD), uterine artery embolization (UAE), laparoscopic ultrasound-guided radiofrequency ablation, and magnetic resonance-guided focused ultrasound ablation (MRgFUS). Applicable Procedure Codes: 0071T, 0072T, 37243, 58563, 58580, 58674, J7296, J7297, J7298, J7301, J7306, S4981.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of levonorgestrel-releasing intrauterine devices (LNG-IUD), uterine artery embolization (UAE), magnetic resonance-guided focused ultrasound ablation (MRgFUS), and ultrasound-guided radiofrequency ablation. Applicable Procedure Codes: 0071T, 0072T, 37243, J7296, J7297, J7298, J7301, J7306, S4981.
Last Published 01.01.2024
Effective 01.01.2024 – This policy addresses termination of pregnancy, spontaneous abortions, and selective fetal reductions.
Last Published 01.01.2024
Effective 01.01.2024 – This policy addresses termination of pregnancy, spontaneous abortions, and selective fetal reductions.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses accreditation requirements for radiologists, radiology centers, and multi-speciality provider groups interested in participating in the UnitedHealthcare Oxford network.
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses inpatient and outpatient acquired brain injury rehabilitation services, in-home acquired brain injury care, biofeedback, cognitive behavior therapy, coma stimulations, and cognitive rehabilitation under custodial care.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Actemra® (tocilizumab) injection for intravenous infusion for the treatment of polyarticular juvenile idiopathic arthritis, rheumatoid arthritis, systemic juvenile idiopathic arthritis, cytokine release syndrome, acute graft-versus-host disease, and immune checkpoint inhibitor-related toxicities. Applicable Procedure Code: J3262.
Last Published 04.01.2024
Acupuncture is the selection and manipulation of specific acupuncture points through the insertion of needles or “needling,” or other “non-needling” techniques focused on these points.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Adakveo® (crizanlizumab-tmca) to reduce the frequency of vasoocclusive crises in patients with sickle cell disease. Applicable Procedure Code: J0791.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Adakveo® (crizanlizumab-tmca) to reduce the frequency of vasoocclusive crises in patients with sickle cell disease. Applicable Procedure Code: J0791.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Adakveo® (crizanlizumab-tmca) to reduce the frequency of vasoocclusive crises in patients with sickle cell disease. Applicable Procedure Code: J0791.
Last Published 04.11.2024
Add-on codes are reimbursable services when reported in addition to the appropriate primary service by the Same Facility reporting the same Federal Tax Identification Number unless otherwise specified within the policy.
Last Published 04.01.2024
Add-on codes are reimbursable services when reported in addition to the appropriate primary service by the Same Individual Physician or Other Qualified Health Care Professional reporting the same Federal Tax Identification Number on the same date of service unless otherwise specified within the policy. Add-on codes reported as Stand-alone codes are not reimbursable services in accordance with Current Procedural Terminology (CPT®) and the Centers for Medicare and Medicaid Services (CMS) guidelines. For the purpose of this policy, the Same Individual Physician or Other Qualified Health Care Professional is the same individual rendering health care services reporting the same Federal Tax Identification number. R0071
Last Published 04.28.2024
Certain medical services performed by professional providers are an integral but separate adjunct component of an authorized or covered medical service. R7114
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Aduhelm® (aducanumab-avwa) for the treatment of Alzheimer’s disease. Applicable Procedure Code: J0172.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Aduhelm® (aducanumab-avwa) for the treatment of Alzheimer’s disease. Applicable Procedure Codes: C9399, J3490, J3590.
Last Published 04.01.2024
The purpose of this policy is to ensure physicians reporting evaluation and management (E/M) services on behalf of their employed Advanced Practice Healthcare Providers are reporting the services correctly to denote that the services were provided in collaboration with a physician. Flag: APPRR
Last Published 08.04.2023
The purpose of this policy is to provide the reimbursement calculation for Advanced Practice Health Care Providers: Physician Assistant (PA), Nurse Practitioner (NP), and Advanced Practice Nurse (APN).
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Adzynma (ADAMTS13, recombinant-krhn) for the treatment of congenital thrombotic thrombocytopenic purpura (cTTP). Applicable Procedure Codes: C9399, J3490, J3590.
Last Published 04.01.2024
After hours or weekend care (CPT®) codes represent services provided, when an individual physician or other health care professional is required to render the services outside of regular posted office hours to treat a patient's urgent illness or condition. This policy outlines when after hours or weekend care codes are considered for separate reimbursement. Flag: AHC
Last Published 09.24.2023
After hours or weekend care is reimbursable, within limitations, when an individual physician or other health care professional is required to provide services outside of regular posted office hours to treat a patient's urgent illness or condition.
Last Published 08.20.2023
This policy addresses edits involving diagnosis (ICD10-CM) codes and CPT© codes with age limitations. Age designations are assigned to select World Health Organization (WHO) International Classification of Diseases, Tenth Revision ICD10-CM) codes based on code descriptions or on publications and guidelines from sources such as professional specialty societies, the Centers for Medicare and Medicaid Services (CMS), the American Medical Association (AMA) or the AHA (American Hospital Association) Coding Clinic.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses airway clearance devices, such as high-frequency chest wall oscillation systems, acoustical or mechanical percussor, positive expiratory pressure and aerosol drug delivery system combination device, and intrapulmonary percussive ventilation (IPV) devices. Applicable Procedure Codes: A7025, A7026, E0481, E0483.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses airway clearance devices, such as high-frequency chest wall oscillation systems, acoustical or mechanical percussor, positive expiratory pressure and aerosol drug delivery system combination device, and intrapulmonary percussive ventilation (IPV) devices. Applicable Procedure Codes: A7025, A7026, E0481, E0483.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses airway clearance devices, such as high-frequency chest wall oscillation systems, acoustical or mechanical percussor, positive expiratory pressure and aerosol drug delivery system combination device, and intrapulmonary percussive ventilation (IPV) devices. Applicable Procedure Codes: A7025, A7026, E0481, E0483.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses airway clearance devices, such as high-frequency chest wall oscillation systems, acoustical or mechanical percussor, positive expiratory pressure and aerosol drug delivery system combination device, and intrapulmonary percussive ventilation (IPV) devices. Applicable Procedure Codes: A7025, A7026, E0481, E0483.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses airway clearance devices, such as high-frequency chest wall oscillation systems, acoustical or mechanical percussor, positive expiratory pressure and aerosol drug delivery system combination device, and intrapulmonary percussive ventilation (IPV) devices. Applicable Procedure Codes: A7025, A7026, E0481, E0483.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses airway clearance devices, such as high-frequency chest wall oscillation systems, acoustical or mechanical percussor, positive expiratory pressure and aerosol drug delivery system combination device, and intrapulmonary percussive ventilation (IPV) devices. Applicable Procedure Codes: A7025, A7026, E0481, E0483.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses airway clearance devices, such as high-frequency chest wall oscillation systems, acoustical or mechanical percussor, positive expiratory pressure and aerosol drug delivery system combination device, and intrapulmonary percussive ventilation (IPV) devices. Applicable Procedure Codes: A7025, A7026, E0481, E0483.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses airway clearance devices, such as high-frequency chest wall oscillation systems, acoustical or mechanical percussor, positive expiratory pressure and aerosol drug delivery system combination device, and intrapulmonary percussive ventilation (IPV) devices. Applicable Procedure Codes: A7025, A7026, E0481, E0483.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses airway clearance devices, such as high-frequency chest wall oscillation systems, and intrapulmonary percussive ventilation (IPV) devices. Applicable Procedure Codes: A7025, A7026, E0481, E0483.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses airway clearance devices, such as high-frequency chest wall oscillation systems, and intrapulmonary percussive ventilation (IPV) devices. Applicable Procedure Codes: A7025, A7026, E0481, E0483.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses airway clearance devices, such as high-frequency chest wall oscillation systems, and intrapulmonary percussive ventilation (IPV) devices. Applicable Procedure Codes: A7025, A7026, E0481, E0483.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses allergy testing, treatment, and supplies, including allergy serum injections.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses allergy testing, treatment, and supplies, including allergy serum injections.
Last Published 01.04.2024
The guideline presents discussion of a new treatment for congenital athymia, allogeneic processed thymus tissue (Rethymic®), and the circumstances under which it is considered medically necessary.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses alpha1-proteinase inhibitors (Aralast NP™, Glassia™, Prolastin®-C, and Zemaira®) for chronic augmentation and maintenance therapy of emphysema due to congenital deficiency of alpha1-proteinase inhibitor (A1-PI)/alpha1-antitrypsin (AAT) deficiency. Applicable Procedure Codes: J0256, J0257.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses alpha1-proteinase inhibitors (Aralast NP™, Glassia™, Prolastin®-C, and Zemaira®) for chronic augmentation and maintenance therapy of emphysema due to congenital deficiency of alpha1-proteinase inhibitor (A1-PI)/alpha1-antitrypsin (AAT) deficiency. Applicable Procedure Codes: J0256, J0257.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses alpha1-proteinase inhibitors (Aralast NP™, Glassia™, Prolastin®-C, and Zemaira®) for chronic augmentation and maintenance therapy of emphysema due to congenital deficiency of alpha1-proteinase inhibitor (A1-PI)/alpha1-antitrypsin (AAT) deficiency. Applicable Procedure Codes: J0256, J0257.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses alpha1-proteinase inhibitors (Aralast NP™, Glassia™, Prolastin®-C, and Zemaira®) for chronic augmentation and maintenance therapy of emphysema due to congenital deficiency of alpha1-proteinase inhibitor (A1-PI)/alpha1-antitrypsin (AAT) deficiency. Applicable Procedure Codes: J0256, J0257.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses alpha1-proteinase inhibitors (Aralast NP™, Glassia™, Prolastin®-C, and Zemaira®) for chronic augmentation and maintenance therapy of emphysema due to congenital deficiency of alpha1-proteinase inhibitor (A1-PI)/alpha1-antitrypsin (AAT) deficiency. Applicable Procedure Codes: J0256, J0257.
Last Published 02.02.2024
This policy addresses reimbursement related to services included as part of an ambulance transportation service, ambulance modifier usage, provider specialty reporting ambulance services and the requirements for reporting Advanced Life Support, Level 2 (ALS2) ambulance transportation.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses emergency ambulance (ground, water, or air) and non-emergency ambulance (ground or air) services.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses emergency ambulance (ground, water, or air) and non-emergency ambulance (ground or air) services. Applicable Procedure Codes: A0382, A0394, A0398, A0422, A0425, A0426, A0427, A0428, A0429, A0430, A0431, A0433, A0434, A0435, A0436, G2022.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses emergency ambulance (ground, water, or air) and non-emergency ambulance (ground or air) services.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses emergency ambulance (ground, water, or air) and non-emergency ambulance (ground or air) services. Applicable Procedure Codes: A0225, A0380, A0382, A0384, A0390, A0392, A0394, A0396, A0398, A0420, A0422, A0424, A0425, A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, A0434, A0435, A0436, A0998, A0999, S0207, S0208, S9960, S9961, T2007.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses emergency ambulance (ground, water, or air) and non-emergency ambulance (ground or air) services. Applicable Procedure Codes: A0225, A0380, A0382, A0384, A0390, A0392, A0394, A0396, A0398, A0420, A0422, A0424, A0425, A0426, A0427 A0428, A0429, A0430, A0431, A0432, A0433, A0434, A0435, A0436, A0998, A0999, S9960, S0207, S0208, S9961, T2007.
Last Published 09.01.2023
Effective Date: 11.01.2023 – This policy addresses emergency ambulance (ground, water, or air) and non-emergency ambulance (ground or air) services.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses emergency ambulance (ground, water, or air) and non-emergency ambulance (ground or air) services.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses emergency ambulance (ground, water, or air) and non-emergency ambulance (ground or air) services. Applicable Procedure Code: A0430, A0431, A0435, A0436, S9960, S9961, T2007, A0225, A0380, A0382, A0384, A0390, A0392, A0394, A0396, A0398, A0420, A0422, A0424, A0425, A0426, A0427, A0428, A0429, A0432, A0433, A0434, A0998, A0999, S0207, S0208.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses emergency ambulance (ground, water, or air) and non-emergency ambulance (ground or air) services.
Last Published 02.01.2024
Effective 02.01.2024 – This policy addresses ambulance transportation by ground or air.
Last Published 09.01.2023
Effective 09.01.2023 – This policy addresses ambulance transportation by ground or air.
Last Published 06.01.2024
This policy addresses ambulatory electroencephalogram (EEG) monitoring to diagnose neurological conditions. Applicable Procedure Codes: 95700, 95705, 95706, 95707, 95708, 95709, 95710, 95711, 95712, 95713, 95714, 95715, 95716, 95717, 95718, 95719, 95720, 95721, 95722, 95723, 95724, 95725, 95726.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Amondys 45® (casimersen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedures Code: J1426.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Amondys 45® (casimersen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1426.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Amondys 45™ (casimersen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1426.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Amondys 45® (casimersen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedures Code: J1426.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Amondys 45® (casimersen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1426.
Last Published 04.01.2024
This policy addresses the appropriate use of modifiers with certain CPT and HCPCS procedure codes. According to the Centers for Medicare and Medicaid Services (CMS), a modifier is a two-character code that is added, when appropriate, to the end of a procedure or service to clarify the services being billed. R5033
Last Published 04.26.2024
This reimbursement policy applies to all health care services billed on CMS 1500 forms and, when specified, to those billed on UB04 forms. Coding methodology, industry-standard reimbursement logic, regulatory requirements, benefits design and other factors are considered in developing reimbursement policy. R7130
Last Published 04.01.2024
UnitedHealthcare's reimbursement policy for anesthesia services is developed in part using the American Society of Anesthesiologists (ASA) Relative Value Guide (RVG®), the ASA CROSSWALK®, and Centers for Medicare and Medicaid Services (CMS) National Correct Coding Initiative (NCCI) Policy Manual, CMS NCCI edits and the CMS National Physician Fee Schedule. Flag: ANS
Last Published 01.17.2024
UnitedHealthcare Community Plan's reimbursement policy for anesthesia services is developed in part using the American Society of Anesthesiologists (ASA) Relative Value Guide (RVG®), the ASA CROSSWALK®, and Centers for Medicare and Medicaid Services (CMS) National Correct Coding Initiative (NCCI) Policy manual, CMS NCCI edits and the CMS National Physician Fee Schedule.
Last Published 02.01.2024
UnitedHealthcare Medicare Advantage's reimbursement policy for anesthesia services is developed in part using the American Society of Anesthesiologists (ASA) Relative Value Guide (RVG®), the ASA CROSSWALK®, and Centers for Medicare and Medicaid UnitedHealthcare Medicare Advantage's reimbursement policy for anesthesia services is developed in part using the American Society of Anesthesiologists (ASA) Relative Value Guide (RVG®), the ASA CROSSWALK®, and Centers for Medicare and Medicaid Services (CMS) methodology.
Last Published 06.01.2024
This policy addresses the use of an anterior segment aqueous drainage device without extraocular reservoir. Applicable Procedure Codes: 0253T, 0449T, 0450T, 0474T, 0671T, 66183, 66189, 66991.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses apheresis/therapeutic apheresis. Applicable Procedure Codes: 0342T, 36511, 36512, 36513, 36514, 36516, 36522, S2120.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses apheresis/therapeutic apheresis. Applicable Procedure Codes: 0342T, 36511, 36512, 36513, 36514, 36516, 36522, S2120.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses apheresis/therapeutic apheresis. Applicable Procedure Codes: 0342T, 36511, 36512, 36513, 36514, 36516, 36522, S2120.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses apheresis/therapeutic apheresis. Applicable Procedure Codes: 0342T, 36511, 36512, 36513, 36514, 36516, 36522, S2120.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses apheresis/therapeutic apheresis. Applicable Procedure Codes: 0342T, 36511, 36512, 36513, 36514, 36516, 36522, S2120.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses apheresis/therapeutic apheresis. Applicable Procedure Codes: 0342T, 36511, 36512, 36513, 36514, 36516, 36522, S2120.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses apheresis/therapeutic apheresis. Applicable Procedure Codes: 0342T, 36511, 36512, 36513, 36514, 36516, 36522, S2120.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses apheresis/therapeutic apheresis. Applicable Procedure Codes: 0342T, 36511, 36512, 36513, 36514, 36516, 36522, S2120.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses apheresis/therapeutic apheresis. Applicable Procedure Codes: 0342T, 36511, 36512, 36513, 36514, 36516, 36522, S2120.
Last Published 02.01.2024
Effective Date: 12.01.2023 – This policy addresses application of desensitizing medicament or resin. Applicable Procedure Codes: D1206, D9910, D9911.
Last Published 02.19.2024
Please review the standards for appointment access and after-hours care, which are alignedwith the state of Maryland’s access requirements.
Last Published 08.01.2023
This reimbursement policy applies to services reported using the UB-04 form or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network facilities, including, but not limited to, non-network authorized and percent of charge contract facilities.
Last Published 04.15.2024
The uniform bill known as the UB-04, also called the CMS-1450, is used by Medicare and third-party payers for billing facility services. F7010
Last Published 05.12.2023
An Assistant Surgeon actively assists the Physician performing a surgical procedure. The Assistant Surgeon services which are reimbursable services are set forth on UnitedHealthcare's Assistant Surgeon Eligible List. Flag: ASU
Last Published 10.31.2023
An Assistant-at-Surgery actively assists the Physician performing a surgical procedure. The Assistant-at-Surgery services which are reimbursable services are set forth on UnitedHealthcare Individual Exchange's Assistant-at-Surgery Eligible List.
Last Published 06.02.2023
An Assistant-at-Surgery actively assists the Physician performing a surgical procedure. Reimbursement for Assistant-at-Surgery services, when reported by the Same Individual Physician or Other Qualified Health Care Professional, is based on whether the Assistant Surgeon is a Physician (designated by modifiers 80, 81 or 82) or another Health Care Professional (designated by modifier AS) acting as the surgical assistant.
Last Published 02.15.2024
An Assistant-at-Surgery actively assists the Physician performing a surgical procedure. The Assistant-at-Surgery services which are reimbursable services are set forth on UnitedHealthcare Community Plan's Assistant-at-Surgery Eligible List.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses assisted administration of clotting factors and coagulant blood products, including home health care services.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses surgical repair for treating athletic pubalgia. Applicable Procedure Codes: 27299, 49659, 49999.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses surgical repair for treating athletic pubalgia. Applicable Procedure Codes: 27299, 49659, 49999.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses surgical repair for treating athletic pubalgia. Applicable Procedure Codes: 27299, 49659, 49999.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses surgical repair for treating athletic pubalgia. Applicable Procedure Codes: 27299, 49659, 49999.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses surgical repair for treating athletic pubalgia. Applicable Procedure Codes: 27299, 49659, 49999.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses surgical repair for treating athletic pubalgia. Applicable Procedure Codes: 27299, 49659, 49999.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses surgical repair for treating athletic pubalgia. Applicable Procedure Codes: 27299, 49659, 49999.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses surgical repair for treating athletic pubalgia. Applicable Procedure Codes: 27299, 49659, 49999.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses surgical repair for treating athletic pubalgia. Applicable Procedure Codes: 27299, 49659, 49999.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses surgical repair for treating athletic pubalgia. Applicable Procedure Codes: 27299, 49659, 49999.
Last Published 04.19.2024
This clinical guideline addresses recommendations for the optimum management of atrial fibrillation.
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses attention deficit hyperactivity disorder (ADHD) medical management, consultation and evaluation services, treatment of underlying coexistent medical conditions, behavior modification, and family counseling.
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses attention deficit hyperactivity disorder (ADHD) medical management, consultation and evaluation services, treatment of underlying coexistent medical conditions, behavior modification, and family counseling.
Last Published 01.12.2024
This policy identifies circumstances in which UnitedHealthcare Community Plan will reimburse physicians or other health care professionals for audiologic/vestibular function testing to identify problems with balance or hearing.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses augmentative and alternative communication (AAC) devices. Applicable Procedure Codes: E2500, E2502, E2504, E2506, E2508, E2510, E2512, E2599.
Last Published 02.01.2024
Effective 02.01.2024 – This policy addresses behavioral health treatment for autism spectrum disorder.
Last Published 02.01.2024
Effective 02.01.2024 – This policy addresses and autism spectrum disorder, including assessment, coordination of care, referral for consultation/evaluation, medical services, speech/occupational/physical therapy, and therapies, educational services, and behavioral services for autism spectrum disorder.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses autologous cellular therapy. Applicable Procedures Codes: 0263T, 0264T, 0265T, 0489T, 0490T, 0565T, 0566T, 0717T, 0718T, 27599.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses autologous cellular therapy. Applicable Procedures Codes: 0263T, 0264T, 0265T, 0489T, 0490T, 0565T, 0566T, 0717T, 0718T, 27599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses autologous cellular therapy. Applicable Procedures Codes: 0263T, 0264T, 0265T, 0489T, 0490T, 0565T, 0566T, 0717T, 0718T, 27599.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses autologous cellular therapy. Applicable Procedures Codes: 0263T, 0264T, 0265T, 0489T, 0490T, 0565T, 0566T, 0717T, 0718T, 27599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses autologous cellular therapy. Applicable Procedures Codes: 0263T, 0264T, 0265T, 0489T, 0490T, 0565T, 0566T, 0717T, 0718T, 27599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses autologous cellular therapy. Applicable Procedures Codes: 0263T, 0264T, 0265T, 0489T, 0490T, 0565T, 0566T, 0717T, 0718T, 27599.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses autologous cellular therapy. Applicable Procedures Codes: 0263T, 0264T, 0265T, 0489T, 0490T, 0565T, 0566T, 0717T, 0718T, 27599.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses autologous cellular therapy. Applicable Procedures Codes: 0263T, 0264T, 0265T, 0489T, 0490T, 0565T, 0566T, 0717T, 0718T, 27599.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses autologous cellular therapy. Applicable Procedures Codes: 0263T, 0264T, 0265T, 0489T, 0490T, 0565T, 0566T, 0717T, 0718T, 27599.
Last Published 04.01.2024
This document articulates UnitedHealthcare’s policy regarding reimbursement to physicians or other health care professionals for codes which are assigned a status code "B" according to the Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS) Relative Value File. R0100A Flag: BBCAD
Last Published 04.01.2024
This document articulates UnitedHealthcare Community Plan’s policy regarding reimbursement to physicians or other health care professionals for codes which are assigned a status code "B" according to the Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS) Relative Value File. R0100
Last Published 02.01.2024
Effective Date: 12.01.2023 – This policy addresses collection of microorganisms for culture and sensitivity and viral culture. Applicable Procedure Codes: D0414, D0415, D0416.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses balloon sinus ostial dilation. Applicable Procedure Codes: 31295, 31296, 31297, 31298, 31299.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses balloon sinus ostial dilation. Applicable Procedure Codes: 31295, 31296, 31297, 31298, 31299.
Last Published 09.01.2023
Effective Date: 11.01.2023 – This policy addresses balloon sinus ostial dilation. Applicable Procedure Codes: 31295, 31296, 31297, 31298, 31299.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses balloon sinus ostial dilation. Applicable Procedure Codes: 31295, 31296, 31297, 31298, 31299.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses balloon sinus ostial dilation. Applicable Procedure Codes: 31295, 31296, 31297, 31298, 31299.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses balloon sinus ostial dilation. Applicable Procedure Codes: 31295, 31296, 31297, 31298, 31299.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses balloon sinus ostial dilation. Applicable Procedure Codes: 31295, 31296, 31297, 31298, 31299.
Last Published 03.01.2024
Effective Date: 10.01.2023 – This policy addresses balloon sinus ostial dilation. Applicable Procedure Codes: 31295, 31296, 31297, 31298, 31299.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses balloon sinus ostial dilation. Applicable Procedure Codes: 31295, 31296, 31297, 31298, 31299.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses balloon sinus ostial dilation. Applicable Procedure Codes: 31295, 31296, 31297, 31298, 31299.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses bariatric surgical procedures, including gastric bypass, gastric banding, sleeve gastrectomy, biliopancreatic bypass, and biliopancreatic diversion with duodenal switch. Applicable Procedure Codes: 0813T, 43290, 43291, 43644, 43645, 43647, 43648, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43843, 43845, 43846, 43847, 43848, 43860, 43865, 43881, 43882, 43886, 43887, 43888, 64590, 64595, 64999.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses bariatric surgical procedures, including gastric bypass, gastric banding, sleeve gastrectomy, biliopancreatic bypass, and biliopancreatic diversion with duodenal switch. Applicable Procedure Codes: 0813T, 43290, 43291, 43644, 43645, 43647, 43648, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43843, 43845, 43846, 43847, 43848, 43860, 43865, 43881, 43882, 43886, 43887, 43888, 64590, 64595, 64999.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses bariatric surgical procedures, including gastric bypass, gastric banding, sleeve gastrectomy, biliopancreatic bypass, and biliopancreatic diversion with duodenal switch. Applicable Procedure Codes: 0813T, 43290, 43291, 43644, 43645, 43647, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43843, 43845, 43846, 43847, 43848, 43860, 43865, 43881, 43882, 43886, 43887, 43888, 64590, 64595, 64999.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses bariatric surgical procedures, including gastric bypass, gastric banding, sleeve gastrectomy, biliopancreatic bypass, and biliopancreatic diversion with duodenal switch. Applicable Procedure Codes: 0813T, 43290, 43291, 43644, 43645, 43647, 43648, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43843, 43845, 43846, 43847, 43848, 43860, 43865, 43881, 43882, 43886, 43887, 43888, 64590, 64595, 64999.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses bariatric surgical procedures, including gastric bypass, gastric banding, sleeve gastrectomy, biliopancreatic bypass, and biliopancreatic diversion with duodenal switch. Applicable Procedure Codes: 43290, 43291, 43644, 43645, 43647, 43648, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43845, 43846, 43847, 43848, 43860, 43865, 43881, 43882, 43886, 43887, 43888, 64590, 64595, 64999.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses bariatric surgical procedures, including gastric bypass, gastric banding, sleeve gastrectomy, biliopancreatic bypass, and biliopancreatic diversion with duodenal switch.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses bariatric surgical procedures. Applicable Procedure Codes: 0813T, 43290, 43291, 43644, 43645, 43647, 43648, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43842, 43843, 43845, 43846, 43847, 43848, 43860, 43865, 43881, 43882, 43886, 43887, 43888, 43999, 64590, 64595, 64999.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses bariatric surgical procedures. Applicable Procedure Codes: 0813T, 43290, 43291, 43644, 43645, 43647, 43648, 43659, 43770, 43771, 43772, 43773, 43774, 43775, 43842, 43843, 43845, 43846, 43847, 43848, 43860, 43865, 43881, 43882, 43886, 43887, 43888, 43999, 64590, 64595, 64999.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses hospital beds, mattresses, and accessories. Applicable Procedure Codes: E0193, E0194, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0277, E0280, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0305, E0310, E0316, E0328, E0329, E0910, E0911.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses hospital beds, mattresses, and accessories.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses hospital beds, mattresses, and accessories. Applicable Procedure Codes: E0193, E0194, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0277, E0280, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0305, E0310, E0316, E0328, E0329, E0910, E0911.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses hospital beds, mattresses, and accessories. Applicable Procedure Codes: E0193, E0194, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0277, E0280, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0305, E0310, E0316, E0328, E0329, E0910, E0911.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses hospital beds, mattresses, and accessories. Applicable Procedure Codes: E0193, E0194, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0277, E0280, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0305, E0310, E0316, E0328, E0329, E0910, E0911.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses hospital beds, mattresses, and accessories. Applicable Procedure Codes: E0193, E0194, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0270, E0277, E0280, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0305, E0310, E0316, E0328, E0329, E0462, E0910, E0911.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses hospital beds, mattresses, and accessories. Applicable Procedure Codes: E0193, E0194, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0277, E0280, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0305, E0310, E0316, E0328, E0329, E0910, E0911.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses hospital beds, mattresses, and accessories. Applicable Procedure Codes: E0193, E0194, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0277, E0280, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0305, E0310, E0316, E0328, E0329, E0910, E0911.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses hospital beds, mattresses, and accessories. Applicable Procedure Codes: E0193, E0194, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0277, E0280, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0305, E0310, E0316, E0328, E0329, E0910, E0911.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses hospital beds, mattresses, and accessories. Applicable Procedure Codes: E0193, E0194, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0277, E0280, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0305, E0310, E0316, E0328, E0329, E0910, E0911, E1399.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses hospital beds, mattresses, and accessories. Applicable Procedure Codes: E0193, E0194, E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0277, E0280, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0305, E0310, E0316, E0328, E0329, E0910, E0911.
Last Published 04.19.2024
This guideline outlines information regarding behavioral health.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Benlysta® (belimumab) injection for intravenous infusion for the treatment of systemic lupus erythematosus (SLE) and active lupus nephritis (LN). Applicable Procedure Code: J0490.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Benlysta® (belimumab) injection for intravenous infusion for the treatment of systemic lupus erythematosus (SLE) and active lupus nephritis (LN). Applicable Procedure Code: J0490.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Benlysta® (belimumab) injection for intravenous infusion for the treatment of systemic lupus erythematosus (SLE) and active lupus nephritis (LN). Applicable Procedure Code: J0490.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Benlysta® (belimumab) injection for intravenous infusion for the treatment of systemic lupus erythematosus (SLE) and active lupus nephritis (LN). Applicable Procedure Code: J0490.
Last Published 04.17.2024
Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes describe unilateral procedures that can be performed on both sides of the body during the same session by the Same Facility. CPT or HCPCS codes with bilateral in their intent or with bilateral written in their description should not be reported with the bilateral modifier 50, or modifiers LT and RT, because the code is inclusive of the Bilateral Procedure.
Last Published 02.21.2024
Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes describe unilateral procedures that can be performed on both sides of the body during the same session by the Same Facility. F7020B
Last Published 11.23.2022
Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes describe unilateral procedures that can be performed on both sides of the body during the same session by the Same Facility.
Last Published 11.14.2022
Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) codes on the UnitedHealthcare Community Plan Bilateral Eligible Procedures Policy List describe unilateral procedures that can be performed on both sides of the body during the same session by the Same Individual Physician or Other Qualified Health Care Professional.
Last Published 10.01.2023
Effective 10.01.2023 – This policy addresses biofeedback for bladder rehabilitation.
Last Published 10.01.2023
Effective 10.01.2023 – This policy addresses biofeedback for bladder rehabilitation, migraine headaches, and acquired brain injury.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses biologic materials for soft and hard tissue regeneration, including collection and application of autologous blood concentrate product. Applicable Procedure Codes: D4265, D4999, and D7921.
Last Published 06.01.2024
This policy addresses the use of biomarkers in cardiovascular (CV) risk assessment. Applicable Procedure Codes: 82172, 82610, 83090, 83695, 83698, 83700, 83701, 83704, 83719, 83721, 86141.
Last Published 06.01.2024
This policy addresses upper and lower eyelid blepharoplasty, brow ptosis repair, upper eyelid blepharoptosis repair, reduction of overcorrection ptosis, ectropion/entropion repair, lid retraction, correction of lagophthalmos, canthoplasty/canthopexy, and floppy eyelid syndrome repair. Applicable Procedure Codes: 15820, 15821, 15822, 15823, 21280, 21282, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67912, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67961, 67966.
Last Published 06.01.2024
This policy addresses blepharoplasty, blepharoptosis, and lid reconstruction. Applicable Procedure Codes: 15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67912, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924.
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses blood and blood products, blood clotting factors, and blood-associated costs.
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses blood and blood products, blood clotting factors, and blood-associated costs.
Last Published 06.01.2024
This policy addresses blood product molecular antigen typing. Applicable Procedure Codes: 0001U, 0084U, 0180U, 0181U, 0182U, 0183U, 184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0221U, 0222U, 81105, 81106, 81107, 81108, 81109, 81110, 81111, 81112.
Last Published 06.01.2024
This policy addresses blood-derived products for chronic non-healing wounds. Applicable Procedure Codes: G0460, G0465.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses bone replacement grafts for retained natural teeth and ridge preservation, and osseous, osteoperiosteal, or cartilage grafting. Applicable Procedure Codes: D3428, D3429, D4263, D4264, D7950, D7953.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of botulinum toxin types A and B, including Dysport® (abobotulinumtoxinA), Xeomin® (incobotulinumtoxinA), Botox® (onabotulinumtoxinA), and Myobloc® (rimabotulinumtoxinB). Applicable Procedure Codes: J0585, J0586, J0587, J0588, J0589.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of botulinum toxin types A and B, including Dysport® (abobotulinumtoxinA), Xeomin® (incobotulinumtoxinA), Botox® (onabotulinumtoxinA), and Myobloc® (rimabotulinumtoxinB). Applicable Procedure Codes: J0585, J0586, J0587, J0588, J0589.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of botulinum toxin types A and B, including Dysport® (abobotulinumtoxinA), Xeomin® (incobotulinumtoxinA), Botox® (onabotulinumtoxinA), and Myobloc® (rimabotulinumtoxinB). Applicable Procedure Codes: C9399, J0585, J0586, J0587, J0588, J3490, J3590.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses the use of botulinum toxin types A and B, including Dysport® (abobotulinumtoxinA), Daxxify® (daxibotulinumtoxinA-lanm), Xeomin® (incobotulinumtoxinA), Botox® (onabotulinumtoxinA), and Myobloc® (rimabotulinumtoxinB). Applicable Procedure Codes: J0585, J0586, J0587, J0588, J0589.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of botulinum toxin types A and B, including Dysport® (abobotulinumtoxinA), Xeomin® (incobotulinumtoxinA), Botox® (onabotulinumtoxinA), and Myobloc® (rimabotulinumtoxinB). Applicable Procedure Codes: J0585, J0586, J0587, J0588, J0589.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses breast imaging for screening for and diagnosing cancer. Applicable Procedure Codes: 0422T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T, 76376, 76377, 76391, 76498, 76499, 76641, 76642, 77046, 77047, 77048, 77049, 77065, 77066, 77067, S8080.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses breast imaging, including digital mammography, magnetic resonance imaging (MRI), ultrasound, automated breast ultrasound system, computer-aided detection (CAD), computer-aided tactile breast imaging, electrical impedance scanning (EIS), magnetic resonance elastography (MRE), and molecular breast imaging. Applicable Procedure Codes: 0422T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T, 76376, 76377, 76391, 76498, 76499, 76641, 76642, 77046, 77047, 77048, 77049, 77065, 77066, 77067, S8080.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses breast imaging, including digital mammography, magnetic resonance imaging (MRI), ultrasound, automated breast ultrasound system, computer-aided detection (CAD), computer-aided tactile breast imaging, electrical impedance scanning (EIS), magnetic resonance elastography (MRE), and molecular breast imaging.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses breast imaging, including digital mammography, magnetic resonance imaging (MRI), ultrasound, automated breast ultrasound system, computer-aided detection (CAD), computer-aided tactile breast imaging, electrical impedance scanning (EIS), magnetic resonance elastography (MRE), and molecular breast imaging. Applicable Procedure Codes: 0422T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T, 76376, 76377, 76391, 76498, 76499, 76641, 76642, 77046, 77047, 77048, 77049, 77065, 77066, 77067, S8080.
Last Published 10.01.2023
Effective Date: 12.01.2023 – This policy addresses breast imaging, including digital mammography, magnetic resonance imaging (MRI), ultrasound, automated breast ultrasound system, computer-aided detection (CAD), computer-aided tactile breast imaging, electrical impedance scanning (EIS), magnetic resonance elastography (MRE), and molecular breast imaging. Applicable Procedure Codes: 0422T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T, 76376, 76377, 76391, 76498, 76499, 76641, 76642, 77046, 77047, S8080.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses breast imaging, including digital mammography, magnetic resonance imaging (MRI), ultrasound, automated breast ultrasound system, computer-aided detection (CAD), computer-aided tactile breast imaging, electrical impedance scanning (EIS), magnetic resonance elastography (MRE), and molecular breast imaging. Applicable Procedure Codes: 0422T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T, 76376, 76377, 76391, 76498, 76499, 76641, 76642, 77046, 77047, S8080.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses breast imaging for screening and diagnosing cancer. Applicable Procedure Codes: 0422T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T, 76376, 76377, 76391, 76498, 76499, 76641, 76642, 77046, 77047, 77048, 77049, 77065, 77066, 77067, S8080.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses breast imaging, including digital mammography, magnetic resonance imaging (MRI), ultrasound, automated breast ultrasound system, computer-aided detection (CAD), computer-aided tactile breast imaging, electrical impedance scanning (EIS), magnetic resonance elastography (MRE), and molecular breast imaging. Applicable Procedure Codes: 0422T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T, 76376, 76377, 76391, 76498, 76499, 76641, 76642, 77046, 77047, 77048, 77049, 77065, 77066, 77067, S8080.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses breast imaging, including digital mammography, magnetic resonance imaging (MRI), ultrasound, automated breast ultrasound system, computer-aided detection (CAD), computer-aided tactile breast imaging, electrical impedance scanning (EIS), magnetic resonance elastography (MRE), and molecular breast imaging. Applicable Procedure Codes: 0422T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T, 76376, 76377, 76391, 76498, 76499, 76641, 76642, 77046, 77047, 77048, 77049, 77065, 77066, 77067, S8080.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses breast imaging, including digital mammography, magnetic resonance imaging (MRI), ultrasound, automated breast ultrasound system, computer-aided detection (CAD), computer-aided tactile breast imaging, electrical impedance scanning (EIS), magnetic resonance elastography (MRE), and molecular breast imaging. Applicable Procedure Codes: 0422T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T, 76376, 76377, 76391, 76498, 76499, 76641, 76642, 77046, 77047, 77048, 77049, 77065, 77066, 77067, S8080.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses breast imaging, including digital mammography, magnetic resonance imaging (MRI), ultrasound, automated breast ultrasound system, computer-aided detection (CAD), computer-aided tactile breast imaging, electrical impedance scanning (EIS), magnetic resonance elastography (MRE), and molecular breast imaging. Applicable Procedure Codes: 0422T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T, 76376, 76377, 76391, 76498, 76499, 76641, 76642, 77046, 77047, 77048, 77049, 77065, 77066, 77067, S8080.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses breast imaging, including digital mammography, magnetic resonance imaging (MRI), ultrasound, automated breast ultrasound system, computer-aided detection (CAD), computer-aided tactile breast imaging, electrical impedance scanning (EIS), magnetic resonance elastography (MRE), and molecular breast imaging. Applicable Procedure Codes: 0422T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T, 76376, 76377, 76391, 76498, 76499, 76641, 76642, 77046, 77047, 77048, 77049, 77065, 77066, 77067, S8080.
Last Published 03.01.2024
Effective Date: 12.01.2023 – This policy addresses breast reconstruction post-mastectomy and for the treatment of Poland syndrome, removal of breast implants, and breast repair and reconstruction not post mastectomy. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses breast reconstruction post-mastectomy and for treatment of Poland syndrome. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses breast reconstruction post-mastectomy and for the treatment of Poland syndrome, removal of breast implants, and breast repair and reconstruction not post mastectomy. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses breast reconstruction post-mastectomy and for the treatment of Poland syndrome, removal of breast implants, and breast repair and reconstruction not post mastectomy. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses breast reconstruction post-mastectomy and for the treatment of Poland syndrome, removal of breast implants, and breast repair and reconstruction not post mastectomy. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses breast reconstruction post-mastectomy and for the treatment of Poland syndrome, removal of breast implants, and breast repair and reconstruction not post mastectomy. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses breast reconstruction. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses breast reconstruction services. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses breast reconstruction post-mastectomy and for the treatment of Poland syndrome, removal of breast implants, and breast repair and reconstruction not post mastectomy. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses breast reconstruction post-mastectomy and for the treatment of Poland syndrome, removal of breast implants, and breast repair and reconstruction not post mastectomy. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950.
Last Published 09.01.2019
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Last Published 04.01.2024
Effective Date: 10.01.2023 – This policy addresses breast reconstruction post-mastectomy and for the treatment of Poland syndrome, removal of breast implants, and breast repair and reconstruction not post mastectomy. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses breast reconstruction post-mastectomy and for the treatment of Poland syndrome, removal of breast implants, and breast repair and reconstruction not post mastectomy. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses breast reconstruction post-mastectomy and for the treatment of Poland syndrome, removal of breast implants, and breast repair and reconstruction not post mastectomy. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 19499, L8600, S2066, S2067, S2068, S8950.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses breast reconstruction post-mastectomy and for the treatment of Poland syndrome, removal of breast implants, and breast repair and reconstruction not post mastectomy. Applicable Procedure Codes: 11920, 11921, 11922, 11970, 11971, 15271, 15272, 15771, 15772, 15777, 19316, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19396, 19499, L8600, S2066, S2067, S2068, S8950.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses breast reduction surgeries. Applicable Procedure Codes: 19316, 19318.
Last Published 06.01.2023
Effective Date: 08.01.2023 – This policy addresses breast reduction surgeries. Applicable Procedure Codes: 19316, 19318.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses breast reduction surgeries. Applicable Procedure Codes: 19316, 19318.
Last Published 06.01.2023
Effective Date: 08.01.2023 – This policy addresses breast reduction surgeries. Applicable Procedure Codes: 19316, 19318.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses breast reduction surgeries. Applicable Procedure Codes: 19316, 19318.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses breast reduction surgeries. Applicable Procedure Code: 19318.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses breast reduction surgeries. Applicable Procedure Code: 19318.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses the use of Brineura® (cerliponase alfa) in pediatric patients with late infantile neuronal ceroid lipofuscinosis (LINCL). Applicable Procedure Code: J0567.
Last Published 12.12.2023
Effective Date: 08.01.2023 – This policy addresses the use of Brineura® (cerliponase alfa) in pediatric patients with late infantile neuronal ceroid lipofuscinosis (LINCL). Applicable Procedure Code: J0567.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Brineura® (cerliponase alfa) in pediatric patients with late infantile neuronal ceroid lipofuscinosis (LINCL). Applicable Procedure Code: J0567.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses the use of Brineura® (cerliponase alfa) in pediatric patients with late infantile neuronal ceroid lipofuscinosis (LINCL). Applicable Procedure Code: J0567.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses the use of Brineura® (cerliponase alfa) in pediatric patients with late infantile neuronal ceroid lipofuscinosis (LINCL). Applicable Procedure Code: J0567.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Briumvi® (ublituximab-xiiy) for the treatment of relapsing forms of multiple sclerosis (MS). Applicable Procedure Code: J2329.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Briumvi® (ublituximab-xiiy) for the treatment of relapsing forms of multiple sclerosis (MS). Applicable Procedure Code: J2329.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Briumvi® (ublituximab-xiiy) for the treatment of relapsing forms of multiple sclerosis (MS). Applicable Procedure Code: J2329.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses bronchial thermoplasty. Applicable Procedure Codes: 31660, 31661.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses bronchial thermoplasty. Applicable Procedure Codes: 31660, 31661.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses bronchial thermoplasty. Applicable Procedure Codes: 31660, 31661.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses bronchial thermoplasty. Applicable Procedure Codes: 31660, 31661.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses bronchial thermoplasty. Applicable Procedure Codes: 31660, 31661.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses bronchial thermoplasty. Applicable Procedure Codes: 31660, 31661.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses bronchial thermoplasty. Applicable Procedure Codes: 31660, 31661.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses bronchial thermoplasty. Applicable Procedure Codes: 31660, 31661.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses brow ptosis, browpexy or internal browlift, eyelid surgery for correction of lagophthalmos, lid retraction surgery, and canthoplasty/canthopexy. Applicable Procedure Codes: 15820, 15821, 15822, 15823, 21280, 21282, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67912, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67950, 67961, 67966.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses brow ptosis, browpexy or internal browlift, eyelid surgery for correction of lagophthalmos, lid retraction surgery, and canthoplasty/canthopexy. Applicable Procedure Codes: 15820, 15821, 15822, 15823, 21280, 21282, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67912, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67950, 67961, 67966.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses upper and lower eyelid blepharoplasty, upper eyelid blepharoptosis repair, brow ptosis, eyelid surgery with an anophthalmic socket, ectropion or punctal eversion, entropion, lid retraction surgery, canthoplasty/canthopexy, and repair of floppy eyelid syndrome (FES).
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses upper and lower eyelid blepharoplasty, upper eyelid blepharoptosis repair, brow ptosis, eyelid surgery with an anophthalmic socket, ectropion or punctal eversion, entropion, lid retraction surgery, canthoplasty/canthopexy, and repair of floppy eyelid syndrome (FES).
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses upper and lower eyelid blepharoplasty, upper eyelid blepharoptosis repair, brow ptosis, eyelid surgery with an anophthalmic socket, ectropion or punctal eversion, entropion, lid retraction surgery, canthoplasty/canthopexy, and repair of floppy eyelid syndrome (FES). Applicable Procedure Codes: 15820, 15821, 15822, 15823, 21280, 21282, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67912, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67950, 67961, 67966.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses brow ptosis, browpexy or internal browlift, eyelid surgery for correction of lagophthalmos, lid retraction surgery, and canthoplasty/canthopexy.
Last Published 10.01.2023
Effective Date: 12.01.2023 – This policy addresses brow ptosis, browpexy or internal browlift, eyelid surgery for correction of lagophthalmos, lid retraction surgery, and canthoplasty/canthopexy.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses brow ptosis, browpexy or internal browlift, eyelid surgery for correction of lagophthalmos, lid retraction surgery, and canthoplasty/canthopexy.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses brow ptosis, browpexy or internal browlift, eyelid surgery for correction of lagophthalmos, lid retraction surgery, and canthoplasty/canthopexy. Applicable Procedure Codes: 15820, 15821, 15822, 15823, 21280, 21282, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67912, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67950, 67961, 67966.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses brow ptosis, browpexy or internal brow lift, eyelid surgery for correction of lagophthalmos, lid retraction surgery, and canthoplasty/canthopexy.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses brow ptosis, browpexy or internal brow lift, eyelid surgery for correction of lagophthalmos, lid retraction surgery, and canthoplasty/canthopexy.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses brow ptosis, browpexy or internal browlift, eyelid surgery for correction of lagophthalmos, lid retraction surgery, and canthoplasty/canthopexy. Applicable Procedure Codes: 15820, 15821, 15822, 15823, 21280, 21282, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67912, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67950, 67961, 67966.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses brow ptosis, browpexy or internal browlift, eyelid surgery for correction of lagophthalmos, lid retraction surgery, and canthoplasty/canthopexy. Applicable Procedure Codes: 15820, 15821, 15822, 15823, 212
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses brow ptosis, browpexy or internal browlift, eyelid surgery for correction of lagophthalmos, lid retraction surgery, and canthoplasty/canthopexy. Applicable Procedure Codes: 15820, 15821, 15822, 15823, 21280, 21282, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67912, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67950, 67961, 67966.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses brow ptosis, browpexy or internal browlift, eyelid surgery for correction of lagophthalmos, lid retraction surgery, and canthoplasty/canthopexy. Applicable Procedure Codes: 15820, 15821, 15822, 15823, 21280, 21282, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67912, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67950, 67961, 67966.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of buprenorphine (Brixadi™ and Sublocade®) for the treatment of opioid dependence/opioid use disorder. Applicable Procedure Codes: C9399, J3490, J3590, Q9991, Q9992.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses the use of buprenorphine (Brixadi™ and Sublocade®) for the treatment of opioid dependence/opioid use disorder. Applicable Procedure Codes: J0577, J0578, Q9991, Q9992.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Buprenorphine (Brixadi™ and Sublocade®) for the treatment of opioid dependence/opioid use disorder. Applicable Procedure Codes: J0577, J0578, Q9991, Q9992.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of buprenorphine (Brixadi™ & Sublocade®) for the treatment of opioid dependence/opioid use disorder. Applicable Procedure Codes: J0577, J0578, Q9991, Q9992.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of buprenorphine (Probuphine®) for the treatment of opioid dependence/opioid use disorder. Applicable Procedure Codes: J0577, J0578.
Last Published 06.01.2024
This policy addresses capsule endoscopy and wireless gastrointestinal motility monitoring systems. Applicable Procedure Codes: 91110, 91111, 91112, 91113, 91299.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses cardiac event monitoring, including ambulatory event monitoring, outpatient cardiac telemetry, and implantable loop recorder. Applicable Procedure Codes: 33285, 93224, 93225, 93226, 93227, 93228, 93229, 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248, 93268, 93270, 93271, 93272, 93285, 93291, 93298, E0616, G2066, 0650T.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses cardiac event monitoring, including ambulatory event monitoring, outpatient cardiac telemetry, and implantable loop recorder. Applicable Procedure Codes: 0650T, 33285, 33286, 93224, 93225, 93226, 93227, 93228, 93229, 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248, 93268, 93270, 93271, 93272, 93285, 93291, 93298, E0616, G2066.
Last Published 05.01.2023
Effective Date:07.01.2023 – This policy addresses cardiac event monitoring, including ambulatory event monitoring, outpatient cardiac telemetry, and implantable loop recorder. Applicable Procedure Codes: 0650T, 33285, 33286, 93224, 93225, 93226, 93227, 93228, 93229, 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248, 93268, 93270, 93271, 93272, 93285, 93291, 93298, E0616, G2066.
Last Published 09.01.2023
Effective Date: 07.01.2023 – This policy addresses cardiac event monitoring, including ambulatory event monitoring, outpatient cardiac telemetry, and implantable loop recorder. Applicable Procedure Codes: 0650T, 33285, 33286, 93224, 93225, 93226, 93227, 93228, 93229, 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248, 93268, 93270, 93271, 93272, 93285, 93291, 93298, E0616, G2066.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses cardiac event monitoring, including ambulatory event monitoring, outpatient cardiac telemetry, and implantable loop recorder. Applicable Procedure Codes: 0650T, 33285, 33286, 93224, 93225, 93226, 93227, 93228, 93229, 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248, 93268, 93270, 93271, 93272, 93285, 93291, 93298, E0616, G2066.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses cardiac event monitoring, including ambulatory event monitoring, outpatient cardiac telemetry, and implantable loop recorder. Applicable Procedure Codes: 0650T, 33285, 33286, 93224, 93225, 93226, 93227, 93228, 93229, 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248, 93268, 93270, 93271, 93272, 93285, 93291, 93297, 93298, 93799, E0616, E1399.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses cardiac event monitoring, including ambulatory event monitoring, outpatient cardiac telemetry, and implantable loop recorder. Applicable Procedure Codes: 0650T, 33285, 33286, 93224, 93225, 93226, 93227, 93228, 93229, 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248, 93268, 93270, 93271, 93272, 93285, 93291, 93297, 93298, 93799, E0616, E1399.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses cardiac event monitoring, including ambulatory event monitoring, outpatient cardiac telemetry, and implantable loop recorder. Applicable Procedure Codes: 0650T, 33285, 33286, 93224, 93225, 93226, 93227, 93228, 93229, 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248, 93268, 93270, 93271, 93272, 93285, 93291, 93297, 93298, 93799, E0616, E1399.
Last Published 02.01.2024
Effective 02.01.2024 – This policy addresses cardiac pacemakers, cardiac pacemaker monitoring, implantable automatic defibrillators, and automatic external defibrillators.
Last Published 02.01.2024
Effective 02.01.2024 – This policy addresses cardiac pacemakers, cardiac pacemaker monitoring, implantable automatic defibrillators, and automatic external defibrillators.
Last Published 06.01.2024
This policy addresses cardiac rehabilitation programs and intensive cardiac rehabilitation programs for chronic heart failure. Applicable Procedure Codes: 93797, 93798 G0422, G0423.
Last Published 02.01.2024
Effective 02.01.2024 – This policy addresses outpatient cardiac rehabilitation services.
Last Published 02.01.2024
Effective 02.01.2024 – This policy addresses outpatient cardiac rehabilitation services.
Last Published 01.02.2024
Effective Date: 01.01.2024 – This policy addresses cardiology procedures requiring precertification with initial review performed by eviCore healthcare.
Last Published 06.01.2024
This policy addresses diagnostic and therapeutic procedures. Applicable Procedure Codes: 37220, 37221, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37220, 37221, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37799, 92978, 92979, 93050, 93653, 93655, 93656.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses arterial compliance testing using waveform analysis, carotid intima-media thickness (CIMT) measurement, advanced lipoprotein analysis, endothelial function assessment, and tests for lipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme, other human A2 phospholipases, and long-chain omega-3 fatty acids. Applicable Procedure Codes: 0052U, 0308U, 0309U, 0377U, 82172, 83695, 83698, 83701, 83704, 84999, 93050, 93799, 93895, 93998.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses arterial compliance testing using waveform analysis, carotid intima-media thickness (CIMT) measurement, advanced lipoprotein analysis, endothelial function assessment, and tests for lipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme, other human A2 phospholipases, and long-chain omega-3 fatty acids. Applicable Procedure Codes: 0019M, 0052U, 0308U, 0309U, 0377U, 0415U, 82172, 83695, 83698, 83701, 83704, 84999, 93050, 93799, 93895, 93998.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses arterial compliance testing using waveform analysis, carotid intima-media thickness (CIMT) measurement, advanced lipoprotein analysis, endothelial function assessment, and tests for lipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme, other human A2 phospholipases, and long-chain omega-3 fatty acids. Applicable Procedure Codes: 0019U, 0052U, 0308U, 0309U, 0377U, 0415U, 82172, 83695, 83698, 83701, 83704, 84999, 93050, 93799, 93895, 93998.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses arterial compliance testing using waveform analysis, carotid intima-media thickness (CIMT) measurement, advanced lipoprotein analysis, endothelial function assessment, and tests for lipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme, other human A2 phospholipases, and long-chain omega-3 fatty acids. Applicable Procedure Codes: 0052U, 0308U, 0309U, 0377U, 82172, 83695, 83698, 83701, 83704, 84999, 93050, 93799, 93895, 93998.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses arterial compliance testing using waveform analysis, carotid intima-media thickness (CIMT) measurement, advanced lipoprotein analysis, endothelial function assessment, and tests for lipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme, other human A2 phospholipases, and long-chain omega-3 fatty acids. Applicable Procedure Codes: 0019M, 0052U, 0308U, 0309U, 0377U, 0415U, 82172, 83695, 83698, 83701, 83704, 84999, 93050, 93799, 93895, 93998.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses arterial compliance testing using waveform analysis, carotid intima-media thickness (CIMT) measurement, advanced lipoprotein analysis, endothelial function assessment, and tests for lipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme, other human A2 phospholipases, long-chain omega-3 fatty acids, and multi-protein biomarkers. Applicable Procedure Codes: 0052U, 0308U, 0309U, 0377U, 0401U, 82172, 83695, 83698, 83701, 83704, 84999, 93050, 93799, 93895, 93998.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses arterial compliance testing using waveform analysis, carotid intima-media thickness (CIMT) measurement, advanced lipoprotein analysis, endothelial function assessment, and tests for lipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme, other human A2 phospholipases, and long-chain omega-3 fatty acids. Applicable Procedure Codes: 0019M, 0052U, 0308U, 0309U, 0377U, 0401U, 0415U, 0423T, 82172, 83695, 83698, 83701, 83704, 93050, 93799, 93895, 93998.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses arterial compliance testing using waveform analysis, carotid intima-media thickness (CIMT) measurement, advanced lipoprotein analysis, endothelial function assessment, and tests for lipoprotein-associated phospholipase A2 (Lp-PLA2) enzyme, other human A2 phospholipases, and long-chain omega-3 fatty acids. Applicable Procedure Codes: 0019M, 0052U, 0308U, 0309U, 0377U, 0401U, 0415U, 82172, 83695, 83698, 83701, 83704, 93050, 93799, 93895, 93998.
Last Published 04.19.2024
This guideline addresses the primary prevention of cardiovascular disease in adults.
Last Published 04.01.2024
Care Plan Oversight (CPO) Services refer to physician and other qualified health care professional supervision of patients under the care of home health agencies, hospice, or nursing facilities. R0033
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Applicable Procedure Codes: 0400U, 81412, 81443, 81479.
Last Published 04.17.2024
Effective Date: 11.01.2023 – This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Applicable Procedure Codes: 0400U, 81412, 81443, 81479.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Applicable Procedure Codes: 0400U, 81412, 81443, 81479.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Applicable Procedure Codes: 0400U, 81412, 81443, 81479.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Applicable Procedure Codes: 0400U, 81412, 81443, 81479.
Last Published 09.01.2023
Effective Date: 11.01.2023 – This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Applicable Procedure Codes: 0400U, 81412, 81443, 81479.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Applicable Procedure Codes: 0400U, 81412, 81443, 81479.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Applicable Procedure Codes: 0400U, 81412, 81443, 81479.
Last Published 05.01.2024
Effective Date: 10.01.2023 – This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Applicable Procedure Codes: 81412, 81443, 81479.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Applicable Procedure Codes: 81412, 81443, 81479.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses the Ashkenazi Jewish carrier screening and expanded carrier screening panel testing. Applicable Procedure Codes: 0400U, 81412, 81443, 81479.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses catheter ablation for atrial fibrillation. Applicable Procedure Codes: 93653, 93655, 93656, 93657.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses catheter ablation for atrial fibrillation. Applicable Procedure Codes: 93653, 93655, 93656, 93657.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses catheter ablation for atrial fibrillation. Applicable Procedure Codes: 93653, 93655, 93656, 93657.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses catheter ablation for atrial fibrillation. Applicable Procedure Codes: 93653, 93655, 93656, 93657.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses catheter ablation for atrial fibrillation. Applicable Procedure Codes: 93653, 93655, 93656, 93657.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses catheter ablation for atrial fibrillation. Applicable Procedure Codes: 93653, 93655, 93656, 93657.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses catheter ablation for atrial fibrillation. Applicable Procedure Codes: 93653, 93655, 93656, 93657.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses catheter ablation for atrial fibrillation. Applicable Procedure Codes: 93653, 93655, 93656, 93657.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses catheter ablation for atrial fibrillation. Applicable Procedure Codes: 93653, 93655, 93656, 93657.
Last Published 05.21.2023
According to the Centers for Medicare and Medicaid Services (CMS), medical and surgical procedures should be reported with the CPT®/HCPCS codes that most comprehensively describe the services performed.
Last Published 04.01.2024
UnitedHealthcare uses this policy to administer the "Column One/Column Two" National Correct Coding Initiative (NCCI) edits not otherwise addressed in UnitedHealthcare reimbursement policies to determine whether CPT and/or HCPCS codes reported together by the Same Individual Physician or Other Health Care Professional for the same member on the same date of service are eligible for separate reimbursement. Flag: CCIDD, CCIDDH, CCIUN, CCIUNH, SCCID, SCCIDH
Last Published 03.26.2023
According to the Centers for Medicare and Medicaid Services (CMS), medical and surgical procedures should be reported with the CPT®/HCPCS codes that most comprehensively describe the services performed. For the purpose of this policy, the Same Individual Physician or Other Health Care Professional is the same individual rendering health care services reporting the same Federal Tax Identification number.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses DNA-based noninvasive prenatal tests. Applicable Procedure Codes: 0060U, 0327U, 0449U, 81420, 81422, 81479, 81507.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses DNA-based noninvasive prenatal tests. Applicable Procedure Codes: 0060U, 0327U, 0449U, 81420, 81422, 81479, 81507.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses DNA-based noninvasive prenatal tests. Applicable Procedure Codes: 0060U, 0327U, 81420, 81422, 81479, 81507.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses DNA-based noninvasive prenatal tests. Applicable Procedure Codes: 0060U, 0327U, 0449U, 81420, 81422, 81479, 81507.
Last Published 08.01.2023
Effective Date: 10.01.2023 – This policy addresses DNA-based noninvasive prenatal tests. Applicable Procedure Codes: 0060U, 0168U, 0327U, 81420, 81422, 81479, 81507.
Last Published 03.25.2024
Effective Date: 10.01.2023 – This policy addresses DNA-based noninvasive prenatal tests. Applicable Procedure Codes: 0060U, 0168U, 0327U, 81420, 81422, 81479, 81507.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses DNA-based noninvasive prenatal tests. Applicable Procedure Codes: 0060U, 0327U, 81420, 81422, 81479, 81507.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses DNA-based noninvasive prenatal tests. Applicable Procedure Codes: 0060U, 0327U, 0449U, 81420, 81422, 81479, 81507.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses DNA-based noninvasive prenatal tests. Applicable Procedure Codes: 0060U, 0327U, 0449U, 81420, 81422, 81479, 81507.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses DNA-based noninvasive prenatal tests. Applicable Procedure Codes: 0060U, 0327U, 0449U, 81420, 81422, 81479, 81507.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses DNA-based noninvasive prenatal tests. Applicable Procedure Codes: 0060U, 0327U, 0449U, 81420, 81422, 81479, 81507.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses chelation therapy. Applicable Procedure Codes: J0470, J0600, J0895, J3490, J3520, J8499, M0300, S9355.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses chelation therapy. Applicable Procedure Codes: J0470, J0600, J0895, J3490, J3520, J8499, M0300, S9355.
Last Published 07.01.2023
Effective Date: 09.01.2023 – This policy addresses chelation therapy. Applicable Procedure Codes: J0470, J0600, J0895, J3490, J3520, J8499, M0300, S9355.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses chelation therapy. Applicable Procedure Codes: J0470, J0600, J0895, J3490, J3520, J8499, M0300, S9355.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses chelation therapy. Applicable Procedure Codes: J0470, J0600, J0895, J3490, J8499, M0300, S9355.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses chelation therapy. Applicable Procedure Codes: J0470, J0600, J0895, J3490, J8499, M0300, S9355.
Last Published 08.01.2023
Effective 08.01.2023 – This policy addresses inpatient and outpatient chemical dependency/substance abuse detoxification services and methadone maintenance.
Last Published 11.01.2023
Effective 11.01.2023 – This policy addresses inpatient and outpatient chemical dependency/substance abuse detoxification services and methadone maintenance.
Last Published 08.01.2023
Effective 08.01.2023 – This policy addresses chemical dependency/substance abuse rehabilitation.
Last Published 08.01.2023
Effective 08.01.2023 – This policy addresses chemical dependency/substance abuse rehabilitation.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses chemotherapy observation or overnight (inpatient) stay.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses chemotherapy observation or overnight (inpatient) stay.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses chemotherapy observation or overnight (inpatient) stay.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses chemotherapy observation or inpatient stay.
Last Published 11.01.2023
Effective 11.01.2023 – This policy addresses chemotherapy, immunotherapy, and hormonal agents, injectable drugs, infusion therapy, oral drugs, and related oncology services.
Last Published 11.01.2023
Effective 11.01.2023 – This policy addresses chemotherapy, immunotherapy, and hormonal agents, injectable drugs, infusion therapy, oral drugs, and related oncology services.
Last Published 04.19.2024
These guidelines outline the evaluation of acute or stable chest pain or other anginal equivalents, in various clinical settings, with an emphasis on the diagnosis on ischemic causes.
Last Published 04.19.2024
This guideline outlines recommendations to address the practical management of individuals with high blood cholesterol and related disorders.
Last Published 05.01.2024
Effective Date: 10.01.2023 – This policy addresses genome-wide comparative genomic hybridization microarray testing or single nucleotide polymorphism (SNP) chromosomal microarray analysis. Applicable Procedure Codes: 0156U, 0209U, 81228, 81229, 81349, 81479, S3870.
Last Published 06.01.2024
Effective Date: 11.01.2023 – This policy addresses genome-wide comparative genomic hybridization microarray testing or single nucleotide polymorphism (SNP) chromosomal microarray analysis. Applicable Procedure Codes: 0156U, 0209U, 81228, 81229, 81349, 81479, S3870.
Last Published 05.01.2024
Effective Date: 10.01.2023 – This policy addresses genome-wide comparative genomic hybridization microarray testing or single nucleotide polymorphism (SNP) chromosomal microarray analysis. Applicable Procedure Codes: 0156U, 0209U, 81228, 81229, 81349, 81479, S3870.
Last Published 08.01.2023
Effective Date: 10.01.2023 – This policy addresses genome-wide comparative genomic hybridization microarray testing or single nucleotide polymorphism (SNP) chromosomal microarray analysis. Applicable Procedure Codes: 0156U, 0209U, 81228, 81229, 81349, 81479, S3870.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses genome-wide comparative genomic hybridization microarray testing or single nucleotide polymorphism (SNP) chromosomal microarray analysis. Applicable Procedure Codes: 0156U, 0209U, 81228, 81229, 81349, 81479, S3870.
Last Published 05.01.2024
Effective Date: 11.01.2023 – This policy addresses genome-wide comparative genomic hybridization microarray testing or single nucleotide polymorphism (SNP) chromosomal microarray analysis. Applicable Procedure Codes: 0156U, 0209U, 81228, 81229, 81349, 81479, S3870.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses genome-wide comparative genomic hybridization microarray testing or single nucleotide polymorphism (SNP) chromosomal microarray analysis. Applicable Procedure Codes: 0156U, 0209U, 81228, 81229, 81349, 81479, S3870.
Last Published 05.01.2024
Effective Date: 10.01.2023 – This policy addresses genome-wide comparative genomic hybridization microarray testing or single nucleotide polymorphism (SNP) chromosomal microarray analysis. Applicable Procedure Codes: 0156U, 0209U, 81228, 81229, 81349, 81479, S3870.
Last Published 05.01.2024
Effective Date: 10.01.2023 – This policy addresses genome-wide comparative genomic hybridization microarray testing or single nucleotide polymorphism (SNP) chromosomal microarray analysis. Applicable Procedure Codes: 0156U, 0209U, 81228, 81229, 81349, 81479, S3870.
Last Published 04.01.2024
Effective Date: 08.01.2023 – This policy addresses genome-wide comparative genomic hybridization microarray testing or single nucleotide polymorphism (SNP) chromosomal microarray analysis. Applicable Procedure Codes: 0156U, 0209U, 81228, 81229, 81479, S3870.
Last Published 04.01.2024
Effective Date: 08.01.2023 – This policy addresses genome-wide comparative genomic hybridization microarray testing or single nucleotide polymorphism (SNP) chromosomal microarray analysis. Applicable Procedure Codes: 0156U, 0209U, 81228, 81229, 81349, 81479, S3870.
Last Published 04.19.2024
This clinical guideline addresses the management of chronic coronary disease.
Last Published 04.19.2024
These practice parameters detail the assessment and treatment modalities for individuals with chronic obstructive lung disease.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Cimzia® (certolizumab pegol) the treatment of Crohn’s disease, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, and plaque psoriasis. Applicable Procedures Codes: 96372, 96401, J0717.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of Cimzia® (certolizumab pegol) the treatment of Crohn’s disease, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, and plaque psoriasis. Applicable Procedures Codes: 96372, 96401, J0717.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of Cimzia® (certolizumab pegol) the treatment of Crohn’s disease, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, and plaque psoriasis. Applicable Procedures Codes: 96372, 96401, J0717.
Last Published 01.30.2024
Based on the CMS National Coverage Determination (NCD) coding policy manual, services that are excluded from coverage include routine physical examinations and services that are not reasonable and necessary for the diagnosis or treatment of an illness or injury. CMS interprets these provisions to prohibit coverage of screening services, including laboratory tests furnished in the absence of signs, symptoms, or personal history of disease or injury. A national coverage policy for diagnostic laboratory test(s) is a document stating CMS’s policy with respect to the circumstances under which the test(s) will be considered reasonable and necessary, and not screening. 8100B
Last Published 11.23.2022
Based on the CMS National Coverage Determination (NCD) coding policy manual, services that are excluded from coverage include routine physical examinations and services that are not reasonable and necessary for the diagnosis or treatment of an illness or injury.
Last Published 01.01.2024
Based on the CMS National Coverage Determination (NCD) coding policy manual, services that are excluded from coverage include routine physical examinations and services that are not reasonable and necessary for the diagnosis or treatment of an illness or injury. CMS interprets these provisions to prohibit coverage of screening services, including laboratory tests furnished in the absence of signs, symptoms, or personal history of disease or injury. A national coverage policy for diagnostic laboratory test(s) is a document stating CMS’s policy with respect to the circumstances under which the test(s) will be considered reasonable and necessary, and not screening.
Last Published 06.01.2024
This policy addresses clinical diagnostic and preventive laboratory services and screenings.
Last Published 04.01.2024
This policy describes the information that is required on certain claims that are reported for laboratory services under the Clinical Laboratory Improvement Amendment (CLIA) 1988 statute and regulations. All services described in this policy may be subject to additional UnitedHealthcare Medicare Advantage reimbursement policies including, but not limited to, the Medical Unlikely Edits (MUE) Policy and the Rebundling CCI Editing Policy.
Last Published 04.01.2024
This policy describes the information that is required on certain claims that are reported for laboratory services under the Clinical Laboratory Improvement Amendment (CLIA) 1988 statute and regulations. R6000
Last Published 02.09.2024
This policy describes the information that is required on certain claims that are reported for laboratory services under the Clinical Laboratory Improvement Amendment (CLIA) 1988 statute and regulations. 6000
Last Published 10.10.2023
This policy describes the information that is required on certain claims that are reported for laboratory services under the Clinical Laboratory Improvement Amendment (CLIA) 1988 statute and regulations.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses clinical trials. Applicable Procedure Codes: G0276, G0293, G0294, G2000, S9988, S9990, S9991, S9992, S9994, S9996.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses clinical trials. Applicable Procedure Codes: G0276, G0293, G0294, G2000, S9988, S9990, S9991, S9992, S9994, S9996.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses clinical trials. Applicable Procedure Codes: G0276, G0293, G0294, G2000, S9988, S9990, S9991, S9992, S9994, S9996.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses clinical trials. Applicable Procedure Codes: G0276, G0293, G0294, G2000, S9988, S9990, S9991, S9992, S9994, S9996.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses clinical trials. Applicable Procedure Codes: G0276, G0293, G0294, G2000, S9988, S9990, S9991, S9992, S9994, S9996.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses clinical trials. Applicable Procedure Codes: G0276, G0293, G0294, G2000, S9988, S9990, S9991, S9992, S9994, S9996.
Last Published 09.01.2023
Effective 09.01.2023 – This policy addresses state mandates pertaining to clinical trials.
Last Published 09.01.2023
Effective 09.01.2023 – This policy addresses state mandates pertaining to clinical trials.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses clotting factors and coagulant blood products. Applicable Procedure Codes: J7170, J7175, J7177, J7178, J7179, J7180, J7181, J7182, J7183, J7185, J7186, J7187, J7188, J7189, J7190, J7192, J7193, J7194, J7195, J7198, J7199, J7200, J7201, J7202, J7203, J7204, J7205, J7207, J7208, J7209, J7210, J7211, J7212, J7213, J7214.
Last Published 04.01.2024
The Co-Surgeon and Team Surgeon Policy identifies which procedures are eligible for Co-Surgeon and Team Surgeon services as identified by the Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS). R0052 Flag: CSU, TSU
Last Published 11.14.2022
The Co-Surgeon and Team Surgeon Policy identifies which procedures are eligible for Co-Surgeon and Team Surgeon services as identified by the Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS).
Last Published 05.20.2024
The Co-Surgeon and Team Surgeon Policy identifies which procedures are eligible for Co-Surgeon and Team Surgeon services as identified by the Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS). A Co-Surgeon is identified by appending modifier 62 to the surgical code. R9010
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses non-hybrid and hybrid cochlear implantation. Applicable Procedure Codes: 69930, L8614, L8615, L8616, L8617, L8618, L8619, L8627, L8628, V5273.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses non-hybrid and hybrid cochlear implantation. Applicable Procedure Codes: 69930, L8614, L8615, L8616, L8617, L8618, L8619, L8627, L8628, V5273.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses non-hybrid and hybrid cochlear implantation. Applicable Procedure Codes: 69930, L8614, L8615, L8616, L8617, L8618, L8619, L8627, L8628, V5273.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses non-hybrid and hybrid cochlear implantation. Applicable Procedure Codes: 69930, L8614, L8615, L8616, L8617, L8618, L8619, L8627, L8628, V5273.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses non-hybrid and hybrid cochlear implantation. Applicable Procedure Codes: 69930, L8614, L8615, L8616, L8617, L8618, L8619, L8627, L8628, V5273.
Last Published 04.01.2024
Effective Date: 11.01.2023 – This policy addresses non-hybrid and hybrid cochlear implantation. Applicable Procedure Codes: 69930, L8614, L8615, L8616, L8617, L8618, L8619, L8627, L8628, V5273.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses non-hybrid and hybrid cochlear implantation. Applicable Procedure Codes: 69930, L8614, L8615, L8616, L8617, L8618, L8619, L8627, L8628, V5273.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses non-hybrid and hybrid cochlear implantation. Applicable Procedure Codes: 69930, L8614, L8615, L8616, L8617, L8618, L8619, L8627, L8628, V5273.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses non-hybrid and hybrid cochlear implantation. Applicable Procedure Codes: 69930, L8614, L8615, L8616, L8617, L8618, L8619, L8627, L8628, V5273.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses non-hybrid and hybrid cochlear implantation. Applicable Procedure Codes: 69930, L8614, L8615, L8616, L8617, L8618, L8619, L8627, L8628, V5273.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses non-hybrid and hybrid cochlear implantation. Applicable Procedure Codes: 69930, L8614, L8615, L8616, L8617, L8618, L8619, L8627, L8628, V5273.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses cognitive rehabilitation and coma stimulation. Applicable Procedure Codes: 97129, 97130, S9056.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses cognitive rehabilitation and coma stimulation. Applicable Procedure Codes: 97129, 97130, S9056.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses cognitive rehabilitation and coma stimulation. Applicable Procedure Codes: 97129, 97130, S9056.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses cognitive rehabilitation and coma stimulation. Applicable Procedure Codes: 97129, 97130, S9056.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses cognitive rehabilitation and coma stimulation. Applicable Procedure Codes: 97129, 97130, S9056.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses cognitive rehabilitation and coma stimulation. Applicable Procedure Codes: 97129, 97130, S9056.
Last Published 03.01.2024
Effective Date: 10.01.2023 – This policy addresses cognitive rehabilitation and coma stimulation. Applicable Procedure Codes: 97129, 97130, S9056.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses cognitive rehabilitation and coma stimulation. Applicable Procedure Codes: 97129, 97130, S9056.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses serum or urine collagen crosslinks or biochemical markers. Applicable Procedure Code: 82523.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses serum or urine collagen crosslinks or biochemical markers. Applicable Procedure Code: 82523.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses serum or urine collagen crosslinks or biochemical markers. Applicable Procedure Code: 82523.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses serum or urine collagen crosslinks or biochemical markers. Applicable Procedure Code: 82523.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses serum or urine collagen crosslinks or biochemical markers. Applicable Procedure Code: 82523.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses serum or urine collagen crosslinks or biochemical markers. Applicable Procedure Code: 82523.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses serum or urine collagen crosslinks or biochemical markers. Applicable Procedure Code: 82523.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses serum or urine collagen crosslinks or biochemical markers. Applicable Procedure Code: 82523.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses serum or urine collagen crosslinks or biochemical markers. Applicable Procedure Code: 82523.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Soliris® (eculizumab) and Ultomiris® (ravulizumab-cwvz). Applicable Procedure Codes: J1300, J1303.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Soliris® (eculizumab) and Ultomiris® (ravulizumab-cwvz). Applicable Procedure Codes: J1300, J1303.
Last Published 06.01.2024
This policy addresses complementary and alternative therapies or services. Applicable Procedure Codes: 64999, A9270.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses complementary and alternative medicine, including acupuncture, chiropractic care, and massage therapy.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses complementary and alternative medicine, including acupuncture, acupressure, chiropractic care, massage therapy, and neuropath.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses computed tomographic colonography. Applicable Procedure Codes: 74261, 74262, 74263.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses computed tomographic colonography. Applicable Procedure Codes: 74261, 74262, 74263.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses computed tomographic colonography. Applicable Procedure Codes: 74261, 74262, 74263.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses computed tomographic colonography. Applicable Procedure Codes: 74261, 74262, 74263.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses computed tomographic colonography. Applicable Procedure Codes: 74261, 74262, 74263.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses computed tomographic colonography. Applicable Procedure Codes: 74261, 74262, 74263.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses computed tomographic colonography. Applicable Procedure Codes: 74261, 74262, 74263.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses computed tomographic colonography. Applicable Procedure Codes: 74261, 74262, 74263.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses computer-assisted surgical navigation for musculoskeletal procedures and the use of intra-operative kinetic balance sensor for implant stability during knee replacement arthroplasty. Applicable Procedure Codes: 0054T, 0055T, 20985, 27599.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses computer-assisted surgical navigation for musculoskeletal procedures and the use of intra-operative kinetic balance sensor for implant stability during knee replacement arthroplasty. Applicable Procedure Codes: 0054T, 0055T, 20985, 27599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses computer-assisted surgical navigation for musculoskeletal procedures and the use of intra-operative kinetic balance sensor for implant stability during knee replacement arthroplasty. Applicable Procedure Codes: 0054T, 0055T, 27599, 20985.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses computer-assisted surgical navigation for musculoskeletal procedures and the use of intra-operative kinetic balance sensor for implant stability during knee replacement arthroplasty. Applicable Procedure Codes: 0054T, 0055T, 20985, 27599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses computer-assisted surgical navigation for musculoskeletal procedures and the use of intra-operative kinetic balance sensor for implant stability during knee replacement arthroplasty. Applicable Procedure Codes: 0054T, 0055T, 20985, 27599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses computer-assisted surgical navigation for musculoskeletal procedures and the use of intra-operative kinetic balance sensor for implant stability during knee replacement arthroplasty. Applicable Procedure Codes: 0054T, 0055T, 27599, 20985.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses computer-assisted surgical navigation for musculoskeletal procedures and the use of intra-operative kinetic balance sensor for implant stability during knee replacement arthroplasty. Applicable Procedures Codes: 0054T, 0055T, 20985, 27599.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses computer-assisted surgical navigation for musculoskeletal procedures and the use of intra-operative kinetic balance sensor for implant stability during knee replacement arthroplasty. Applicable Procedures Codes: 0054T, 0055T, 20985.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses computer-assisted surgical navigation for musculoskeletal procedures and the use of intra-operative kinetic balance sensor for implant stability during knee replacement arthroplasty. Applicable Procedures Codes: 0054T, 0055T, 20985, 27599.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses computerized dynamic posturography (CDP) testing. Applicable Procedure Codes: 92548, 92549.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses computerized dynamic posturography (CDP) testing. Applicable Procedure Codes: 92548, 92549.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses computerized dynamic posturography (CDP) testing. Applicable Procedure Codes: 92548, 92549.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses computerized dynamic posturography (CDP) testing. Applicable Procedure Codes: 92548, 92549.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses computerized dynamic posturography (CDP) testing. Applicable Procedure Codes: 92548, 92549.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses computerized dynamic posturography (CDP) testing. Applicable Procedure Codes: 92548, 92549.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses computerized dynamic posturography (CDP) testing. Applicable Procedure Codes: 92548, 92549.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses computerized dynamic posturography (CDP) testing. Applicable Procedure Codes: 92548, 92549.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses cone beam computed tomography (CBCT). Applicable Procedures Codes: D0364, D0365, D0366, D0367, D0368, D0380, D0381, D0382, D0383, D0384, D0391, D0393, D0394, D0395.
Last Published 04.01.2024
This policy discusses how UnitedHealthcare evaluates CPT® consultation codes 99241-99245 and 99251-99255 and Healthcare Common procedure Coding System (HCPCS) codes G0406-G0408 and G0425-G0427 for reimbursement.
Last Published 02.01.2024
Effective 02.01.2024 – This policy addresses continuity of care conditions and continuing care with a terminated provider for members.
Last Published 02.01.2024
Effective 02.01.2024 – This policy addresses continuity of care and continuing care with a terminated provider for members.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses continuous glucose monitoring for diabetes management. Applicable Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4238, A9276, A9277, A9278, E1399, E2102, S1030, S1031.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Applicable Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4211, A4226, A4238, A4239, A9274, A9276, A9277, A9278, E0784, E0787, E1399, E2102, E2103, S1030, S1031, S1034, S1035, S1036, S1037.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Applicable Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4211, A4226, A4238, A4239, A9274, A9276, A9277, A9278, E0784, E0787, E1399, E2102, E2103, S1030, S1031, S1034, S1035, S1036, S1037.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Applicable Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4211, A4226, A4238, A4239, A9274, A9276, A9277, A9278, E0784, E0787, E1399, E2102, E2103, S1030, S1031, S1034, S1035, S1036, S1037.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Applicable Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4211, A4226, A4238, A4239, A9274, A9276, A9277, A9278, E0784, E0787, E1399, E2102, E2103, S1030, S1031, S1034, S1035, S1036, S1037.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Applicable Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4211, A4226, A4238, A4239, A9274, A9276, A9277, A9278, E0784, E0787, E1399, E2102, E2103, S1030, S1031, S1034, S1035, S1036, S1037.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Applicable Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4211, A4226, A4238, A4239, A9274, A9276, A9277, A9278, E0784, E0787, E1399, E2102, S1030, S1031, S1034, S1035, S1036, S1037.
Last Published 07.01.2023
Effective Date: 08.01.2023 – This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Applicable Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4211, A4226, A4238, A4239, A9274, A9276, A9277, A9278, E0784, E0787, E1399, E2102, E2103, S1030, S1031, S1034, S1035, S1036, S1037.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Applicable Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4211, A4226, A4238, A4239, A9274, A9276, A9277, A9278, E0784, E0787, E1399, E2102, E2103, S1030, S1031, S1034, S1035, S1036, S1037.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Applicable Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4211, A4226, A4238, A4239, A9274, A9276, A9277, A9278, E0784, E0787, E1399, E2102, E2103, S1030, S1031, S1034, S1035, S1036, S1037.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Applicable Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4211, A4226, A4238, A4239, A9274, A9276, A9277, A9278, E0784, E0787, E1399, E2102, E2103, S1030, S1031, S1034, S1035, S1036, S1037.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Applicable Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4211, A4226, A4238, A4239, A9274, A9276, A9277, A9278, E0784, E0787, E1399, E2102, E2103, S1030, S1031, S1034, S1035, S1036, S1037.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses insulin delivery and continuous glucose monitoring for diabetes management. Applicable Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4211, A4238, A4239, A9274, A9276, A9277, A9278, E0784, E1399, E2102, E2103, S1030, S1031, S1034, S1035, S1036, S1037.
Last Published 05.01.2024
This policy identifies circumstances where UnitedHealthcare Community Plan will reimburse physicians and other qualified health care professionals for High and Low Osmolar Contrast and Radiopharmaceutical Materials. R0104A.LA
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses restorative foundation for an indirect restoration, core buildup (including any pins when required), post and core, pin retention, and post removal. Applicable Procedure Codes: D2949, D2950, D2951, D2952, D2953, D2954, D2955, D2957, D2999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses core decompression for avascular necrosis. Applicable Procedure Codes: 21299, 23929, 27299, 27599, 27899, S2325.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses core decompression for avascular necrosis. Applicable Procedure Codes: 21299, 23929, 27299, 27599, 27899, S2325.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses core decompression for avascular necrosis. Applicable Procedure Codes: 21299, 23929, 27299, 27599, 27899, S2325.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses core decompression for avascular necrosis. Applicable Procedure Codes: 21299, 23929, 27299, 27599, 27899, S2325.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses core decompression for avascular necrosis. Applicable Procedure Codes: 21299, 23929, 27299, 27599, 27899, S2325.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses core decompression for avascular necrosis. Applicable Procedure Codes: 21299, 23929, 27299, 27599, 27899, S2325.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses core decompression for avascular necrosis. Applicable Procedure Codes: 21299, 23929, 27299, 27599, 27899, S2325.
Last Published 12.01.2023
Effective Date: 11.01.2023 – This policy addresses core decompression for avascular necrosis. Applicable Procedure Codes: 21299, 23929, 27299, 27599, 27899, S2325.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses core decompression for avascular necrosis. Applicable Procedure Codes: 21299, 23929, 27299, 27599, 27899, S2325.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses core decompression avascular necrosis. Applicable Procedure Codes: 21299, 23929, 27299, 27599, 27899, S2325.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses corneal collagen cross-linking (C-CXL) for the treatment of progressive keratoconus and corneal ectasia. Applicable Procedure Codes: 0402T, J2787.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses corneal collagen cross-linking (C-CXL) for the treatment of progressive keratoconus and corneal ectasia. Applicable Procedure Codes: 0402T, J2787.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses corneal collagen cross-linking (C-CXL) for the treatment of progressive keratoconus and corneal ectasia. Applicable Procedure Codes: 0402T, J2787.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses corneal collagen cross-linking (C-CXL) for the treatment of progressive keratoconus and corneal ectasia. Applicable Procedure Codes: 0402T, J2787.
Last Published 06.01.2023
Effective Date: 09.01.2023 – This policy addresses corneal collagen cross-linking (C-CXL) for the treatment of progressive keratoconus and corneal ectasia. Applicable Procedure Codes: 0402T, J2787.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses corneal collagen cross-linking (C-CXL) for the treatment of progressive keratoconus and corneal ectasia. Applicable Procedure Codes: 0402T, J2787.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses corneal collagen cross-linking (C-CXL) for the treatment of progressive keratoconus and corneal ectasia. Applicable Procedure Codes: 0402T, J2787.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses corneal collagen cross-linking (C-CXL) for the treatment of progressive keratoconus and corneal ectasia. Applicable Procedure Codes: 0402T, J2787.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses corneal collagen cross-linking (C-CXL) for the treatment of progressive keratoconus and corneal ectasia. Applicable Procedure Codes: 0402T, J2787.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses corneal collagen cross-linking (C-CXL) for the treatment of progressive keratoconus and corneal ectasia. Applicable Procedure Codes: 0402T, J2787.
Last Published 06.01.2024
This policy addresses computerized corneal topography. Applicable Procedure Code: 92025.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses provisional splinting. Applicable Procedure Codes: D4322, D4323.
Last Published 04.19.2024
This guideline outlines information regarding the optimal management of COVID-19.
Last Published 03.01.2024
Effective Date: 11.01.2023 – This policy addresses cosmetic and reconstructive procedures.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses cosmetic and reconstructive procedures.
Last Published 03.01.2024
Effective Date: 11.01.2023 – This policy addresses cosmetic and reconstructive procedures.
Last Published 03.01.2024
Effective Date: 11.01.2023 – This policy addresses cosmetic and reconstructive procedures.
Last Published 03.01.2024
Effective Date: 11.01.2023 – This policy addresses cosmetic and reconstructive procedures.
Last Published 09.01.2023
Effective Date: 11.01.2023 – This policy addresses cosmetic and reconstructive procedures.
Last Published 03.01.2024
Effective Date: 11.01.2023 – This policy addresses cosmetic and reconstructive procedures.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses cosmetic and reconstructive procedures.
Last Published 09.01.2023
Effective Date: 11.01.2023 – This policy addresses cosmetic and reconstructive procedures.
Last Published 03.01.2024
Effective Date: 11.01.2023 – This policy addresses cosmetic and reconstructive procedures.
Last Published 03.01.2024
Effective Date: 11.01.2023 – This policy addresses cosmetic and reconstructive procedures.
Last Published 03.01.2024
Effective Date: 10.01.2023 – This policy addresses cosmetic and reconstructive procedures.
Last Published 06.01.2024
This policy addresses cosmetic and reconstructive surgical services.
Last Published 03.01.2024
Effective Date: 08.01.2023 – This policy addresses cosmetic and reconstructive procedures.
Last Published 03.01.2024
Effective Date: 08.01.2023 – This policy addresses cosmetic and reconstructive procedures.
Last Published 06.01.2024
This policy addresses cosmetic, reconstructive, and plastic surgery services and procedures.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses cosmetic, reconstructive, and plastic surgical procedures.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses cosmetic, reconstructive, and plastic surgical procedures.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses cosmetic, reconstructive, and plastic surgical procedures.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses cosmetic, reconstructive, and plastic surgical procedures.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses cosmetic, reconstructive, and plastic surgical procedures.
Last Published 01.01.2024
Effective 01.01.2024 – This policy addresses court, attorney, or agency requested services, including emergency and urgently needed services.
Last Published 01.01.2024
Effective 01.01.2024 – This policy addresses court, attorney, or agency requested services, including emergency and urgently needed services.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses credentialing guidelines for radiologists and cardiologists interested in participating in the eviCore healthcare network.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Crysvita®(burosumab-twza) for the treatment of X-linked hypophosphatemia (XLH) and Fibroblast Growth Factor 23 (FGF23)-related hypophosphatemia in tumor-induced osteomalacia (TIO). Applicable Procedure Code: J0584.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Crysvita® (burosumab-twza) for the treatment of X-linked hypophosphatemia (XLH) and Fibroblast Growth Factor 23 (FGF23)-related hypophosphatemia in tumor-induced osteomalacia (TIO). Applicable Procedure Code: J0584.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Crysvita® (burosumab-twza) for the treatment of X-linked hypophosphatemia (XLH) and Fibroblast Growth Factor 23 (FGF23)-related hypophosphatemia in tumor-induced osteomalacia (TIO). Applicable Procedure Code: J0584.
Last Published 06.01.2023
Effective Date: 07.01.2023 – This policy addresses the use of Crysvita® (burosumab-twza) for the treatment of X-linked hypophosphatemia (XLH) and Fibroblast Growth Factor 23 (FGF23)-related hypophosphatemia in tumor-induced osteomalacia (TIO). Applicable Procedure Code: J0584.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Crysvita® (burosumab-twza) for the treatment of X-linked hypophosphatemia (XLH) and Fibroblast Growth Factor 23 (FGF23)-related hypophosphatemia in tumor-induced osteomalacia (TIO). Applicable Procedure Code: J0584.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Crysvita® (burosumab-twza) for the treatment of X-linked hypophosphatemia (XLH) and Fibroblast Growth Factor 23 (FGF23)-related hypophosphatemia in tumor-induced osteomalacia (TIO). Applicable Procedure Code: J0584.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Crysvita® (burosumab-twza) for the treatment of X-linked hypophosphatemia (XLH) and Fibroblast Growth Factor 23 (FGF23)-related hypophosphatemia in tumor-induced osteomalacia (TIO). Applicable Procedure Code: J0584.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses breast ductal lavage, breast ductal fluid aspiration and cytology, and fiberoptic ductoscopy with or without ductal lavage. Applicable Procedure Code: 19499.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses breast ductal lavage, breast ductal fluid aspiration and cytology, and fiberoptic ductoscopy with or without ductal lavage. Applicable Procedure Code: 19499.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses breast ductal lavage, breast ductal fluid aspiration and cytology, and fiberoptic ductoscopy with or without ductal lavage. Applicable Procedure Code: 19499.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses breast ductal lavage, breast ductal fluid aspiration and cytology, and fiberoptic ductoscopy with or without ductal lavage. Applicable Procedure Code: 19499.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses breast ductal lavage, breast ductal fluid aspiration and cytology, and fiberoptic ductoscopy with or without ductal lavage. Applicable Procedure Code: 19499.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses breast ductal lavage, breast ductal fluid aspiration and cytology, and fiberoptic ductoscopy with or without ductal lavage. Applicable Procedure Code: 19499.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses breast ductal lavage, breast ductal fluid aspiration and cytology, and fiberoptic ductoscopy with or without ductal lavage. Applicable Procedure Code: 19499.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses breast ductal lavage, breast ductal fluid aspiration and cytology, and fiberoptic ductoscopy with or without ductal lavage. Applicable Procedure Code: 19499.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses breast ductal lavage, breast ductal fluid aspiration and cytology, and fiberoptic ductoscopy with or without ductal lavage. Applicable Procedure Code: 19499.
Last Published 04.01.2024
Effective Date 04.01.2024 – This policy addresses deep brain and responsive cortical stimulation. Applicable Procedure Codes: 61850, 61860, 61863, 61864, 61867, 61868, 61885, 61886, 61889, 61891, 64999, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses deep brain stimulation and responsive cortical stimulation. Applicable Procedure Codes: 61850, 61860, 61863, 61864, 61867, 61868, 61885, 61886, 61889, 61891, 64999, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses deep brain stimulation and responsive cortical stimulation. Applicable Procedure Codes: 61850, 61860, 61863, 61864, 61867, 61868, 61885, 61886, 64999, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses deep brain stimulation and responsive cortical stimulation. Applicable Procedure Codes: 61850, 61860, 61863, 61864, 61867, 61868, 61885, 61886, 61889, 61891, 64999, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses deep brain stimulation and responsive cortical stimulation. Applicable Procedure Codes: 61850, 61860, 61863, 61864, 61867, 61868, 61885, 61886, 64999, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses conventional deep brain stimulation and responsive cortical stimulation. Applicable Procedure Codes: 61850, 61860, 61863, 61864, 61867, 61868, 61885, 61886, 61889, 61891, 64999, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses conventional deep brain stimulation and responsive cortical stimulation. Applicable Procedure Codes: 61850, 61860, 61863, 61864, 61867, 61868, 61885, 61886, 61889, 61891, 64999, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses deep brain and responsive cortical stimulation. Applicable Procedure Codes: 61850, 61860, 61863, 61864, 61867, 61868, 61885, 61886, 61889, 61891, 64999, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses deep brain stimulation and responsive cortical stimulation. Applicable Procedure Codes: 61850, 61860, 61863, 61864, 61867, 61868, 61885, 61889, 61891, 61886, 64999, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses deep brain stimulation and responsive cortical stimulation. Applicable Procedure Codes: 61850, 61860, 61863, 61864, 61867, 61868, 61885, 61886, 64999, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses deep brain stimulation and responsive cortical stimulation. Applicable Procedure Codes: 61850, 61860, 61863, 61864, 61867, 61868, 61885, 61886, 61889, 61891, 64999, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 04.19.2024
This practice guideline contains general and specific treatment recommendations for patients with Alzheimer’s disease and other dementias.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses certain specialty injectable drug products that are only covered under the pharmacy benefit, including growth hormones, insulin-like growth factors, interferon alpha, monoclonal antibodies, multiple sclerosis agents, osteoporosis treatments, and tumor necrosis factor (TNF) antagonists.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of denosumab (Prolia® & Xgeva®). Applicable Procedure Code: J0897.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of denosumab (Prolia® & Xgeva®). Applicable Procedure Code: J0897.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses the use of denosumab (Prolia® & Xgeva®). Applicable Procedure Code: J0897.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of denosumab (Prolia® & Xgeva®). Applicable Procedure Code: J0897.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses guided tissue regeneration with resorbable and non-resorbable barriers. Applicable Procedures Codes: D6106, D6107, D3432, D4266, D4267, D4286, D7956, D7957.
Last Published 11.01.2023
Effective 11.01.2023 – This policy addresses dental care services and oral surgery.
Last Published 11.01.2023
Effective 11.01.2023 – This policy addresses dental care services and oral surgery.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses dental care under general anesthesia in a hospital operating room (OR) or ambulatory surgery center (ASC).
Last Published 01.10.2024
This UnitedHealthcare Dental Form applies to the Dental Coverage Guideline titled Dental Care Services in an Operating Room or Ambulatory Surgery Center.
Last Published 02.01.2024
Effective Date: 01.01.2024 – This policy addresses dental implants and treatment of peri-implant defects and disease.
Last Published 02.01.2024
Effective Date: 11.01.2023 – This policy addresses dental implant supported prostheses.
Last Published 06.01.2024
This policy addresses dental services or oral surgery, temporomandibular joint (TMJ), and orthognathic surgery. Applicable Procedure Codes: 21120, 21121, 21122, 21123, 21125, 21127, 21141, 21142, 21143, 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21188, 21193, 21194, 21195, 21196, 21198, 21199, 21206, 21210, 21215, 21244, 21245, 21246, 21247, E0849, E0855, E1700, E1701, E1702.
Last Published 11.01.2023
Effective 11.01.2023 – This policy addresses services for the treatment of developmental delay and learning disabilities. This policy applies to members with diagnosed or suspected developmental delay, either global or limited to a specific developmental area.
Last Published 11.01.2023
Effective 11.01.2023 – This policy addresses services for the treatment of developmental delay and learning disabilities. This policy applies to members with diagnosed or suspected developmental delay, either global or limited to a specific developmental area.
Last Published 04.19.2024
This clinical guideline outlines the care of the diabetic patient including screening, diagnosis, and treatment options.
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses diabetic management and treatment, including outpatient diabetic self-management training, diabetic supplies and equipment, continuous subcutaneous insulin infusion pump (CSII) and related supplies, visual aids, pen delivery systems, test strips, diabetic tablets, and insulin syringes.
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses diabetic management and treatment, including outpatient diabetic self-management training, diabetic supplies and equipment, continuous subcutaneous insulin infusion pump (CSII) and related supplies, visual aids, pen delivery systems, test strips, diabetic tablets, and insulin syringes.
Last Published 05.01.2024
This policy addresses reimbursement guidelines for reporting appropriate ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) diagnosis on an Inpatient and Outpatient Facility UB04 claim form or Professional CMS-1500 claim form or its electronic equivalent. R5034
Last Published 05.29.2024
This policy addresses reimbursement guidelines for reporting appropriate ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) diagnosis on an Inpatient and Outpatient Facility UB04 claim form or Professional CMS-1500 claim form or its electronic equivalent. R7131
Last Published 05.01.2024
This policy addresses reimbursement guidelines for reporting appropriate ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) diagnosis on an Inpatient and Outpatient Facility UB04 claim form or Professional CMS-1500 claim form or its electronic equivalent.
Last Published 11.01.2023
Effective 11.01.2023 – This policy addresses inpatient and outpatient diagnostic and therapeutic radiological services, including standard X-rays and specialized scanning, imaging and other specialized procedures.
Last Published 11.01.2023
Effective 11.01.2023 – This policy addresses inpatient and outpatient diagnostic and therapeutic radiological services, including standard X-rays and specialized scanning, imaging and other specialized procedures.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses dynamic spinal visualization techniques and vertebral motion analysis. Applicable Procedure Codes: 0693T, 76120, 76125, 76496, 76499.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses dynamic spinal visualization techniques and vertebral motion analysis. Applicable Procedure Codes: 0693T, 76120, 76125, 76496, 76499.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses dynamic spinal visualization techniques and vertebral motion analysis. Applicable Procedure Codes: 0693T, 76120, 76125, 76496, 76499.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses dynamic spinal visualization techniques and vertebral motion analysis. Applicable Procedure Codes: 0693T, 76120, 76125, 76496, 76499.
Last Published 12.01.2023
Effective Date: 12.01.23 – This policy addresses dynamic spinal visualization techniques and vertebral motion analysis. Applicable Procedure Codes: 0693T, 76120, 76125, 76496, 76499.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses dynamic spinal visualization techniques and vertebral motion analysis. Applicable Procedure Codes: 0693T, 76120, 76125, 76496, 76499.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses dynamic spinal visualization techniques and vertebral motion analysis. Applicable Procedure Codes: 0693T, 76120, 76125, 76496, 76499.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses dynamic spinal visualization techniques and vertebral motion analysis. Applicable Procedure Codes: 0693T, 76120, 76125, 76496, 76499.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses dynamic spinal visualization techniques and vertebral motion analysis. Applicable Procedure Codes: 0693T, 76120, 76125, 76496, 76499.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses dynamic spinal visualization techniques and vertebral motion analysis. Applicable Procedure Codes: 0693T, 76120, 76125, 76496, 76499.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses dynamic spinal visualization techniques and vertebral motion analysis. Applicable Procedure Codes: 0693T, 76120, 76125, 76496, 76499.
Last Published 06.01.2024
This policy addresses diagnostic radiology services.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses spinal and paraspinal ultrasonography. Applicable Procedure Code: 76800.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses spinal and paraspinal ultrasonography. Applicable Procedure Code: 76800.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses spinal and paraspinal ultrasonography. Applicable Procedure Code: 76800.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses spinal and paraspinal ultrasonography. Applicable Procedure Code: 76800.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses spinal and paraspinal ultrasonography. Applicable Procedure Code: 76800.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses spinal and paraspinal ultrasonography. Applicable Procedure Code: 76800.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses spinal and paraspinal ultrasonography. Applicable Procedure Code: 76800.
Last Published 01.01.2024
Effective 01.01.2024 – This policy addresses acute and chronic dialysis (peritoneal or hemodialysis) services and supplies.
Last Published 01.01.2024
Effective 01.01.2024 – This policy addresses acute/sudden and chronic long term dialysis (peritoneal or hemodialysis) services.
Last Published 04.19.2024
This guideline provides information and advice for choosing a healthy eating pattern that focuses on nutrient-dense foods and beverages and contributes to achieving and maintaining a healthy weight.
Last Published 02.25.2024
This policy describes reimbursement guidelines for appropriately reporting discarded drugs and biologicals, identified by modifier JW, administered from single use vials, single use packages, and multi-use vials. R6004A
Last Published 04.14.2024
This policy describes reimbursement guidelines for appropriately reporting discarded drugs and biologicals, identified by modifier JW, administered from single use vials, single use packages, and multi-use vials. Providers may be reimbursed for discarded drugs and biologicals when appropriately reported based on the policy reimbursement guidelines. All services described in this policy may be subject to additional UnitedHealthcare reimbursement policies including, but not limited to, the CCI Editing Policy and Maximum Frequency per Day. R6004 Flag: DDBHD, DDBDN, eDDBDN, eDDBHD
Last Published 01.01.2024
The Discarded Drugs and Biologicals policy addresses reimbursement guidelines for appropriately reporting wasted drugs and biologicals administered from single use vials, single use packages, and multi-use vials. Physicians and other providers may be reimbursed for discarded drugs and biologicals if appropriately reported based on the policy reimbursement guidelines.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses thermal intradiscal procedures (TIPs) and percutaneous discectomy and decompression procedures for treating discogenic pain, and annulus fibrosus repair following spinal surgery. Applicable Procedure Codes: 0627T, 0628T, 0629T, 0630T, 22526, 22527, 22899, S2348.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses annular closure devices (ACDs), percutaneous injection of allogeneic cellular/tissue-based products, percutaneous discectomy and decompression procedures, and thermal intradiscal procedures (TIPs) for treating discogenic pain. Applicable Procedure Codes: 0627T, 0628T, 0629T, 0630T, 22526, 22527, 22899, S2348.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses thermal intradiscal procedures (TIPs) and percutaneous discectomy and decompression procedures for treating discogenic pain, and annulus fibrosus repair following spinal surgery. Applicable Procedure Codes: 0627T, 0628T, 0629T, 0630T, 22526, 22527, 22899, S2348.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses thermal intradiscal procedures (TIPs) and percutaneous discectomy and decompression procedures for treating discogenic pain, and annulus fibrosus repair following spinal surgery. Applicable Procedure Codes: 0627T, 0628T, 0629T, 0630T, 22526, 22527, 22899, S2348.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses thermal intradiscal procedures (TIPs) and percutaneous discectomy and decompression procedures for treating discogenic pain, and annulus fibrosus repair following spinal surgery. Applicable Procedure Codes: 0627T, 0628T, 0629T, 0630T, 22526, 22527, 22899, S2348.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses thermal intradiscal procedures (TIPs) and percutaneous discectomy and decompression procedures for treating discogenic pain, and annulus fibrosus repair following spinal surgery. Applicable Procedure Codes: 0627T, 0628T, 0629T, 0630T, 22526, 22527, 22899, S2348.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses thermal intradiscal procedures (TIPs) and percutaneous discectomy and decompression procedures for treating discogenic pain, and annulus fibrosus repair following spinal surgery. Applicable Procedure Codes: 0627T, 0628T, 0629T, 0630T, 22526, 22527, 22899, S2348.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses thermal intradiscal procedures (TIPs) and percutaneous discectomy and decompression procedures for treating discogenic pain, and annulus fibrosus repair following spinal surgery. Applicable Procedure Codes: 0627T, 0628T, 0629T, 0630T, 22526, 22527, 22899, S2348.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses annular closure devices (ACDs), percutaneous injection of allogeneic cellular/tissue-based products, and thermal intradiscal procedures (TIPs) for treating discogenic pain. Applicable Procedure Codes: 0627T, 0628T, 0629T, 0630T, 22526, 22527, 22899, S2348.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses annular closure devices (ACDs), percutaneous injection of allogeneic cellular/tissue-based products, percutaneous discectomy and decompression procedures, and thermal intradiscal procedures (TIPs) for treating discogenic pain. Applicable Procedure Codes: 0627T, 0628T, 0629T, 0630T, 22526, 22527, 22899, S2348.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses annular closure devices (ACDs), percutaneous injection of allogeneic cellular/tissue-based products, percutaneous discectomy and decompression procedures, and thermal intradiscal procedures (TIPs) for treating discogenic pain. Applicable Procedure Codes: 0627T, 0628T, 0629T, 0630T, 22526, 22527, 22899, S2348.
Last Published 04.01.2024
The term "Discontinued Procedure" designates a surgical or diagnostic procedure provided by a physician or other health care professional that was less than usually required for the procedure as defined in the Current Procedural Terminology (CPT®) book.
Last Published 02.07.2024
This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals.
Last Published 05.01.2024
This policy enforces the code description for presumptive and definitive drug testing in that the service should be reported once per day and it includes specimen validity testing.
Last Published 04.01.2024
This policy defines the daily and annual limits for presumptive drug testing codes (codes 80305, 80306, 80307, and H0003) and definitive drug testing codes (G0480, G0481, G0482, G0483, G0659, 0006U, 0007U, 0011U, and 0020U) and addresses Specimen Validity Testing. Flag: DTP
Last Published 02.25.2024
This policy defines the daily and annual limits for presumptive (CPT® codes 80305, 80306, 80307, and H0003) and definitive drug testing (HCPCS codes G0480, G0481, G0482, G0483 G0659, 0006U, 0007U, 0011U, and 0082U and CPT Definitive Drug Classes Codes 80320-80377, 83992) and addresses Specimen Validity Testing. R6005A.LA
Last Published 03.01.2024
This policy describes the reimbursement methodology for Healthcare Common Procedure Coding System (HCPCS) codes representing Durable Medical Equipment Charges, Parenteral and Enteral Nutrition (PEN) Items and Services listed on the Centers for Medicare and Medicaid PEN Fee Schedule and Medicare Durable Medical Equipment, Prosthetics & Orthotics (DMEPOS) Fee Schedule when billed in Skilled Nursing Facility (SNF) Place of Service (POS) by a Physician or Other Qualified Health Care Professional. R9002
Last Published 03.11.2024
This policy describes how UnitedHealthcare Community Plan reimburses for the rental and/or purchase of certain items of Durable Medical Equipment (DME), Prosthetics and Orthotics. R0109A.LA
Last Published 04.14.2024
This policy describes how UnitedHealthcare reimburses for the rental and/or purchase of certain items of Durable Medical Equipment (DME), Prosthetics and Orthotics.
Last Published 05.01.2023
This policy describes how UnitedHealthcare Medicare Advantage reimburses for the rental and/or purchase of certain items of Durable Medical Equipment (DME), Orthotics and Prosthetics Policy (DMEOP). The provisions of this policy apply to the Same Specialty Physicians and Other Qualified Health Care Professionals, which includes DME, Prosthetic and Orthotic vendors, renting or selling DME, Prosthetics or Orthotics.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses durable medical equipment (DME), orthotics, medical supplies, and repairs/replacements.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses durable medical equipment (DME), orthotics, ostomy supplies, medical supplies and repairs/replacements.
Last Published 06.01.2024
Effective Date: 12.01.2023 – This policy addresses durable medical equipment (DME), orthotics, ostomy supplies, medical supplies and repairs/replacements.
Last Published 06.01.2024
Effective Date: 02.01.2024 – This policy addresses durable medical equipment (DME), orthotics, medical supplies, and repairs/replacements.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses durable medical equipment (DME), orthotics, medical supplies, and repairs/replacements.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses durable medical equipment (DME), orthotics, medical supplies, and repairs/replacements.
Last Published 06.01.2024
Effective Date: 02.01.2024 – This policy addresses durable medical equipment (DME), orthotics, medical supplies, and repairs/replacements.
Last Published 06.01.2024
Effective Date: 02.01.24 – This policy addresses durable medical equipment (DME), orthotics, medical supplies, and repairs/replacements.
Last Published 06.01.2024
Effective Date: 02.01.2024 – This policy addresses durable medical equipment (DME), orthotics, medical supplies, and repairs/replacements.
Last Published 10.01.2023
Effective Date: 09.01.2023 – This policy addresses durable medical equipment (DME), orthotics, ostomy supplies, medical supplies and repairs/replacements.
Last Published 07.29.2019
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Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses planned elective inpatient admission for certain surgeries or procedures.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses planned elective inpatient admission for certain surgeries or procedures.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses planned elective inpatient admission for certain surgeries or procedures.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses planned elective inpatient admission for certain surgeries or procedures.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses planned elective inpatient admission for certain surgeries or procedures.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses planned elective inpatient admission for certain surgeries or procedures.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses planned elective inpatient admission for certain surgeries or procedures.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses planned elective inpatient admission for certain surgeries or procedures.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses planned elective inpatient admission for certain surgeries or procedures.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses planned elective inpatient admission for certain surgeries or procedures.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of devices to generate electric tumor treatment fields (TTF). Applicable Procedure Codes: 77299, A4555, E0766.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of devices to generate electric tumor treatment fields (TTF). Applicable Procedure Codes: 77299, A4555, E0766.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of devices to generate electric tumor treatment fields (TTF). Applicable Procedure Codes: 77299, A4555, E0766.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of devices to generate electric tumor treatment fields (TTF). Applicable Procedure Codes: 77299, A4555, E0766.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of devices to generate electric tumor treatment fields (TTF). Applicable Procedure Codes: 77299, A4555, E0766.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of devices to generate electric tumor treatment fields (TTF). Applicable Procedure Codes: 77299, A4555, E0766.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of devices to generate electric tumor treatment fields (TTF). Applicable Procedure Codes: 77299, A4555, E0766.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of devices to generate electric tumor treatment fields (TTF). Applicable Procedure Codes: 77299, A4555, E0766.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of devices to generate electric tumor treatment fields (TTF). Applicable Procedure Codes: 77299, A4555, E0766.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of devices to generate electric tumor treatment fields (TTF). Applicable Procedure Codes: 77299, A4555, E0766.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses electrical and ultrasonic bone growth stimulators. Applicable Procedure Codes: 20974, 20975, 20979, E0747, E0748, E0749, E0760.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses electrical and ultrasound bone growth stimulators. Applicable Procedure Codes: 20974, 20975, 20979, E0747, E0748, E0749, E0760.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses electrical and ultrasonic bone growth stimulators. Applicable Procedure Codes: 20974, 20975, 20979, E0747, E0748, E0749, E0760.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses electrical and ultrasonic bone growth stimulators. Applicable Procedure Codes: 20974, 20975, 20979, E0747, E0748, E0749, E0760.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses electrical and ultrasonic bone growth stimulators. Applicable Procedure Codes: 20974, 20975, 20979, E0747, E0748, E0749, E0760.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses electrical and ultrasonic bone growth stimulators. Applicable Procedure Codes: 20974, 20975, 20979, E0747, E0748, E0749, E0760.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses electrical and ultrasonic bone growth stimulators. Applicable Procedure Codes: 20974, 20975, 20979, E0747, E0748, E0749, E0760.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses electrical and ultrasonic bone growth stimulators. Applicable Procedure Codes: 20974, 20975, 20979, E0747, E0748, E0749, E0760.
Last Published 06.01.2024
Effective Date: 01.01.2024 – This policy addresses electrical and ultrasonic bone growth stimulators. Applicable Procedure Codes: 20974, 20975, 20979, E0747, E0748, E0749, E0760.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses electrical and ultrasonic bone growth stimulators. Applicable Procedure Codes: 20974, 20975, 20979, E0747, E0748, E0749, E0760.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses electrical and ultrasonic bone growth stimulators. Applicable Procedure Codes: 20974, 20975, 20979, E0747, E0748, E0749, E0760.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses electrical stimulation and electromagnetic therapy for ulcers or wounds. Applicable Procedure Codes: E0769, G0281, G0282, G0295, G0329.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses electrical stimulation for the treatment of pain and muscle rehabilitation, including transcutaneous electrical nerve stimulator (TENS), functional electrical stimulation (FES), and neuromuscular electrical stimulation (NMES). Applicable Procedure Codes: 0278T, 0720T, 0783T, 63650, 63655, 63663, 63664, 63685, 64555, 64596, 64597, 64598, 64999, A4556, A4557, A4595, E0720, E0730, E0731, E0744, E0745, E0764, E0770, E1399, L8678, L8679, L8680, L8682, L8685, L8686, L8687, L8688, S8130, S8131.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses functional electrical stimulation (FES) and neuromuscular electrical stimulation (NMES). Applicable Procedure Codes: 0278T, 0720T, 63650, 63655, 63663, 63664, 63685, 64555, 64999, A4556, A4557, A4595, E0720, E0730, E0731, E0744, E0745, E0764, E0770, E1399, L8679, L8680, L8682, L8685, L8686, L8687, L8688, S8130, S8131.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses electrical stimulation for the treatment of pain and muscle rehabilitation. Applicable Procedure Codes: 0278T, 0720T, 0783T, 63650, 63655, 63663, 63664, 63685, 64555, 64596, 64597, 64598, 64999, A4556, A4557, A4595, E0720, E0730, E0731, E0744, E0745, E0764, E0770, E1399, L8678, L8679, L8680, L8682, L8685, L8686, L8687, L8688, S8130, S8131.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses electrical stimulation for the treatment of pain and muscle rehabilitation, including transcutaneous electrical nerve stimulator (TENS), functional electrical stimulation (FES), and neuromuscular electrical stimulation (NMES). Applicable Procedure Codes: 0278T, 0720T, 0783T, 63650, 63655, 63663, 63664, 63685, 64555, 64596, 64597, 64598, 64999, A4556, A4557, A4595, E0720, E0730, E0731, E0744, E0745, E0764, E0770, E1399, L8678, L8679, L8680, L8682, L8685, L8686, L8687, L8688, S8130, S8131.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses electrical stimulation for the treatment of pain and muscle rehabilitation, including transcutaneous electrical nerve stimulator (TENS), functional electrical stimulation (FES), and neuromuscular electrical stimulation (NMES). Applicable Procedure Codes: 0278T, 0720T, 0783T, 63650, 63655, 63663, 63664, 63685, 64555, 64596, 64597,64598, 64999, A4556, A4557, A4595, E0720, E0730, E0731, E0744, E0745, E0764, E0770, E1399, L8678, L8679, L8680, L8682, L8685, L8686, L8687, L8688, S8130, S8131.
Last Published 06.01.2023
Effective Date: 06.01.2023 – This policy addresses implanted electrical stimulator for spinal cord. Applicable Procedure Codes: 0278T, 0720T, 0783T, 63650, 63655, 63663, 63664, 63685, 64555, 64999, A4556, A4557, A4595, E0720, E0730, E0731, E0744, E0745, E0764, E0770, E1399, L8678, L8679, L8680, L8682, L8685, L8686, L8687, L8688, S8130, S8131.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses implanted electrical stimulator for spinal cord. Applicable Procedure Codes: 0278T, 0720T, 0783T, 63650, 63655, 63663, 63664, 63685, 64555, 64596, 64597, 64598, 64999, A4438, A4556, A4557, A4593, A4594, A4595, E0720, E0730, E0731, E0744, E0745, E0764, E0770, E1399, L8678, L8679, L8680, L8682, L8685, L8686, L8687, L8688, S8130, S8131.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses electrical stimulation for the treatment of pain and muscle rehabilitation. Applicable Procedure Codes: 0278T, 0720T, 0783T, 63650, 63655, 63663, 63664, 63685, 64555, 64999, A4438, A4556, A4557, A4593, A4594, A4595, E0720, E0730, E0731, E0744, E0745, E0764, E0770, E1399, L8678, L8679, L8680, L8682, L8685, L8686, L8687, L8688, S8130, S8131.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses electrical stimulation for the treatment of pain and muscle rehabilitation, including transcutaneous electrical nerve stimulator (TENS), functional electrical stimulation (FES), and neuromuscular electrical stimulation (NMES). Applicable Procedure Codes: 0278T, 0720T, 63650, 63655, 63663, 63664, 63685, 64555, 64596, 64597, 64598, 64999, A4438, A4556, A4557, A4558, A4593, A4594, A4595, A4630, E0720, E0730, E0731, E0744, E0745, E0762, E0764, E0770, E1399, L8679, L8680, L8682, L8685, L8686, L8687, L8688, S8130, S8131.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses electrical stimulation for the treatment of pain and muscle rehabilitation, including transcutaneous electrical nerve stimulator (TENS), functional electrical stimulation (FES), and neuromuscular electrical stimulation (NMES). Applicable Procedure Codes: 0278T, 0720T, 0783T, 63650, 63655, 63663, 63664, 63685, 64555, 64999, A4438, A4556, A4557, A4593, A4594, A4595, E0720, E0730, E0731, E0744, E0745, E0764, E0770, E1399, L8679, L8680, L8682, L8685, L8686, L8687, L8688, S8130, S8131.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses electrical stimulation for the treatment of pain and muscle rehabilitation. Applicable Procedure Codes: 0278T, 0720T, 63650, 63655, 63663, 63664, 63685, 64555, 64596, 64597, 64598, 64999, A4438, A4556, A4557, A4558, A4593, A4594, A4595, A4630, E0720, E0730, E0731, E0744, E0745, E0762, E0764, E0770, E1399, K1023, L8679, L8680, L8682, L8685, L8686, L8687, L8688, S8130, S8131.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses electrical stimulation and electromagnetic therapy for wounds. Applicable Procedure Codes: G0281, G0282.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses electrical stimulation for wounds. Applicable Procedure Codes: G0281, G0282.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses electrical stimulation for the treatment of wounds. Applicable Procedure Codes: G0281, G0282.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses electrical stimulation for the treatment of wounds. Applicable Procedure Codes: G0281, G0282.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses electrical stimulation for the treatment of wounds. Applicable Procedure Codes: G0281, G0282.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses electrical stimulation for the treatment of wounds. Applicable Procedure Codes: G0281, G0282.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses electrical stimulation for the treatment of wounds. Applicable Procedure Codes: G0281, G0282.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses electrical stimulation for wounds. Applicable Procedure Codes: G0281, G0282.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses electrical stimulation and electromagnetic therapy for wounds. Applicable Procedure Codes: E0769, G0295, G0329.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses electromagnetic therapy for wounds. Applicable Procedure Codes: E0769, G0295, G0329.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses electromagnetic therapy for wounds. Applicable Procedure Codes: E0769, G0295, G0329.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses electrical stimulation and electromagnetic therapy for ulcers or wounds. Applicable Procedure Codes: E0769, G0295, G0329.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses electromagnetic therapy for wounds. Applicable Procedure Codes: E0769, G0295, G0329.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses electrical stimulation and electromagnetic therapy for wounds. Applicable Procedure Codes: E0769, G0295, G0329.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses electrical stimulation and electromagnetic therapy for treating ulcers or wounds. Applicable Procedure Codes: E0769, G0281, G0282, G0295, G0329.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses multifocal electroretinogram (mfERG), pattern electroretinogram (PERG), and pattern electroretinogram optimized for glaucoma screening (PERGLA). Applicable Procedure Codes: 0509T, 92274.
Last Published 03.01.2024
Effective Date: 04.01.2024 – This policy addresses multifocal electroretinogram (mfERG), pattern electroretinogram (PERG), and pattern electroretinogram optimized for glaucoma screening (PERGLA). Applicable Procedure Codes: 0509T, 92274.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses multifocal electroretinogram (mfERG), pattern electroretinogram (PERG), and pattern electroretinogram optimized for glaucoma screening (PERGLA). Applicable Procedure Codes: 0509T, 92274.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses multifocal electroretinogram (mfERG), pattern electroretinogram (PERG), and pattern electroretinogram optimized for glaucoma screening (PERGLA). Applicable Procedure Codes: 0509T, 92274.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses multifocal electroretinogram (mfERG), pattern electroretinogram (PERG), and pattern electroretinogram optimized for glaucoma screening (PERGLA). Applicable Procedure Codes: 0509T, 92274.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses multifocal electroretinogram (mfERG), pattern electroretinogram (PERG), and pattern electroretinogram optimized for glaucoma screening (PERGLA). Applicable Procedure Codes: 0509T, 92274.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses multifocal electroretinogram (mfERG), pattern electroretinogram (PERG), and pattern electroretinogram optimized for glaucoma screening (PERGLA). Applicable Procedure Codes: 0509T, 92274.
Last Published 02.01.2024
Effective Date: 04.01.2024 – This policy addresses multifocal electroretinogram (mfERG), pattern electroretinogram (PERG), and pattern electroretinogram optimized for glaucoma screening (PERGLA). Applicable Procedure Codes: 0509T, 92274.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses multifocal electroretinogram (mfERG), pattern electroretinogram (PERG), and pattern electroretinogram optimized for glaucoma screening (PERGLA). Applicable Procedure Codes: 0509T, 92274.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses multifocal electroretinogram (mfERG), pattern electroretinogram (PERG), and pattern electroretinogram optimized for glaucoma screening (PERGLA). Applicable Procedure Codes: 0509T, 92274.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses multifocal electroretinogram (mfERG), pattern electroretinogram (PERG), and pattern electroretinogram optimized for glaucoma screening (PERGLA). Applicable Procedure Codes: 0509T, 92274.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses multifocal electroretinogram (mfERG), pattern electroretinogram (PERG), and pattern electroretinogram optimized for glaucoma screening (PERGLA). Applicable Procedure Codes: 0509T, 92274.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses multifocal electroretinogram (mfERG), pattern electroretinogram (PERG), and pattern electroretinogram optimized for glaucoma screening (PERGLA). Applicable Procedure Codes: 0509T, 92274.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses multifocal electroretinogram (mfERG), pattern electroretinogram (PERG), and pattern electroretinogram optimized for glaucoma screening (PERGLA). Applicable Procedure Codes: 0509T, 92274.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses Elevidys™ (delandistrogene moxparvovec-rokl) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Codes: J1413.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Elevidys™ (delandistrogene moxparvovec-rokl) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1413.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Elevidys™ (delandistrogene moxparvovec-rokl) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1413.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of Eloctate® [antihemophilic factor (recombinant), FC fusion protein] for the treatment of Hemophilia A. Applicable Procedure Codes: J7199, J7205.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses embolization of the ovarian or internal iliac veins. Applicable Procedure Code: 37241.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses embolization of the ovarian or internal iliac veins. Applicable Procedure Code: 37241.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses embolization of the ovarian or internal iliac veins. Applicable Procedure Code: 37241.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses embolization of the ovarian or internal iliac veins. Applicable Procedure Code: 37241.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses embolization of the ovarian or internal iliac veins. Applicable Procedure Code: 37241.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses embolization of the ovarian or internal iliac veins. Applicable Procedure Code: 37241.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses embolization of the ovarian or internal iliac veins. Applicable Procedure Code: 37241.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses embolization of the ovarian or internal iliac veins. Applicable Procedure Code: 37241.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses embolization of the ovarian or internal iliac veins. Applicable Procedure Code: 37241.
Last Published 02.01.2024
Effective 02.01.2024 – This policy addresses emergency services and urgently needed services.
Last Published 02.01.2024
Effective 02.01.2024 – This policy addresses emergency services and urgently needed services.
Last Published 04.03.2024
This policy describes how UnitedHealthcare reimburses UB claims billed with Evaluation and Management (E/M) codes Level 4 (99284/G0383) and Level 5 (99285/G0384) for services rendered in an emergency department. This policy is based on coding principles established by the Centers for Medicare and Medicaid Services (CMS), and the CPT and HCPCS code descriptions.
Last Published 05.25.2023
This policy describes how UnitedHealthcare Medicare Advantage Plan reimburses UB claims billed with Evaluation and Management (E/M) codes Level 4 (99284/G0383) and Level 5 (99285/G0384) for services rendered in an emergency department. This policy is based on coding principles established by the Centers for Medicare and Medicaid Services (CMS)1 , and the CPT and HCPCS code descriptions.
Last Published 03.12.2024
This policy describes how facilities will be reimbursed for emergent and non-emergent services to UnitedHealthcare Community Plan members who seek services at the Emergency Room.
Last Published 04.04.2023
This policy describes how Florida facilities will be reimbursed for non-emergent services to UnitedHealthcare Community Plan Florida M*Plus Managed Medical Assistance (MMA) members who seek services at the Emergency Room.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Enjaym® (sutimlimab-jome) for the treatment of cold agglutinin disease (CAD). Applicable Procedure Code: J1302.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Enjaymo® (sutimlimab-jome) for the treatment of cold agglutinin disease (CAD). Applicable Procedure Code: J1302.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Enjaymo® (sutimlimab-jome) for the treatment of cold agglutinin disease (CAD). Applicable Procedure Code: J1302.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Enjaymo® (sutimlimab-jome) for the treatment of cold agglutinin disease (CAD). Applicable Procedure Code: J1302.
Last Published 04.01.2023
Effective Date: 04.01.2023 – This policy addresses the use of Enjaymo™ (sutimlimab-jome) for the treatment of cold agglutinin disease (CAD). Applicable Procedure Code: J1302.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses enteral nutrition, including enteral formulas and low protein modified food products. Applicable Procedure Codes: B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, S9432, S9433, S9435.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses enteral nutrition, including enteral formulas and low protein modified food products. Applicable Procedure Codes: B4100, B4102, B4103, B4104, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, B9002, S9433, S9434, S9435.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of enteral formulas, enteral pumps, and low protein modified food products. Applicable Procedure Codes: B4100, B4102, B4103, B4104, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, S9432, S9433, S9434, S9435.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses oral and enteral nutrition. Applicable Procedure Codes: B4100, B4102, B4103, B4104, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, S9432, S9433, S9434, S9435.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses oral and enteral nutrition. Applicable Procedure Codes: B4100, B4102, B4103, B4104, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, S9432, S9433, S9434, S9435.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses oral and enteral nutrition. Applicable Procedure Codes: B4100, B4102, B4103, B4104, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, S9432, S9433, S9434, S9435.
Last Published 06.01.2023
Effective Date: 08.01.2023 – This policy addresses the use of enteral formulas, enteral pumps, and low protein modified food products. Applicable Procedure Codes: B4100, B4102, B4103, B4104, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, B9002, B4034, B4034, B4035, B4036, B4081, B4082, B4083, B4087, B4088, B9002, B9004, B9006, S9432, S9433, S9434, S9435.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses oral and enteral nutrition. Applicable Procedure Codes: B4100, B4102, B4103, B4104, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, S9432, S9433, S9434, S9435.
Last Published 06.01.2023
Effective Date: 08.01.2023 – This policy addresses the use of enteral formulas, enteral pumps, and low protein modified food products. Applicable Procedure Codes: B4100, B4102, B4103, B4104, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, S9432, S9433, S9434, S9435.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses enteral nutrition, including enteral formulas and low protein modified food products. Applicable Procedure Codes: B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, S9432, S9433, S9435.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses enteral nutrition, including enteral formulas and low protein modified food products. Applicable Procedure Codes: B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, S9432, S9433, S9435.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Entyvio® (vedolizumab) for the treatment of Crohn's disease, ulcerative colitis, and immune checkpoint inhibitor-related toxicities. Applicable Procedure Code: J3380.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Entyvio® (vedolizumab) for the treatment of Crohn's disease, ulcerative colitis, and immune checkpoint inhibitor-related toxicities. Applicable Procedure Code: J3380.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses sublingual immunotherapy. Applicable Procedure Codes: 95115, 95117, 95165, 95199.
Last Published 09.20.2023
Effective Date: 09.20.2023 – This policy addresses epidural steroid injections. Applicable Procedure Codes: 62320, 62321, 62322, 62323, 64479, 64480, 64483, 64484.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses epidural steroid injections for spinal pain. Applicable Procedure Codes: 62320, 62321, 62322, 62323, 64479, 64480, 64483, 64484.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses epidural steroid injections for spinal pain. Applicable Procedure Codes: 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 64479, 64480, 64483, 64484.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses epidural steroid injections for spinal pain. Applicable Procedure Codes: 62320, 62321, 62322, 62323, 64479, 64480, 64483, 64484.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses epidural steroid injections for spinal pain. Applicable Procedure Codes: 62320, 62321, 62322, 62323, 64479, 64480, 64483, 64484.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses epidural steroid injections for spinal pain. Applicable Procedure Codes: 62320, 62321, 62322, 62323, 64479, 64480, 64483, 64484.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses functional anesthetic discography (FAD), provocative discography, epiduroscopy (including spinal myeloscopy), and percutaneous and endoscopic epidural lysis of adhesions for the diagnosis or treatment of any type of neck, back, or spinal disorder. Applicable Procedure Codes: 62263, 62264, 62290, 62291, 62292, 64999, 72285, 72295.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses functional anesthetic discography (FAD), provocative discography, epiduroscopy (including spinal myeloscopy), and percutaneous and endoscopic epidural lysis of adhesions for the diagnosis or treatment of any type of neck, back, or spinal disorder. Applicable Procedure Codes: 62263, 62264, 62290, 62291, 62292, 64999, 72285, 72295.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses functional anesthetic discography (FAD), provocative discography, epiduroscopy (including spinal myeloscopy), and percutaneous and endoscopic epidural lysis of adhesions for the diagnosis or treatment of any type of neck, back, or spinal disorder. Applicable Procedure Codes: 62263, 62264, 62290, 62291, 62292, 64999, 72285, 72295.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses functional anesthetic discography (FAD), provocative discography, epiduroscopy (including spinal myeloscopy), and percutaneous and endoscopic epidural lysis of adhesions for the diagnosis or treatment of any type of neck, back, or spinal disorder. Applicable Procedure Codes: 62263, 62264, 62290, 62291, 62292, 64999, 72285, 72295.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses functional anesthetic discography (FAD), provocative discography, epiduroscopy (including spinal myeloscopy), and percutaneous and endoscopic epidural lysis of adhesions for the diagnosis or treatment of any type of neck, back, or spinal disorder. Applicable Procedure Codes: 62263, 62264, 62290, 62291, 62292, 64999, 72285, 72295.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses functional anesthetic discography (FAD), provocative discography, epiduroscopy (including spinal myeloscopy), and percutaneous and endoscopic epidural lysis of adhesions for the diagnosis or treatment of any type of neck, back, or spinal disorder. Applicable Procedure Codes: 62263, 62264, 62290, 62291, 62292, 64999, 72285, 72295.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses functional anesthetic discography (FAD), provocative discography, epiduroscopy (including spinal myeloscopy), and percutaneous and endoscopic epidural lysis of adhesions for the diagnosis or treatment of any type of neck, back, or spinal disorder. Applicable Procedure Codes: 62263, 62264, 62290, 62290, 62292, 64999, 72285, 72295.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses functional anesthetic discography (FAD), provocative discography, epiduroscopy (including spinal myeloscopy), and percutaneous and endoscopic epidural lysis of adhesions for the diagnosis or treatment of any type of neck, back, or spinal disorder. Applicable Procedure Codes: 62263, 62264, 62290, 62291, 64999, 72285, 72295.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of erythropoiesis-stimulating agents (ESAs), including Aranesp® (darbepoetin alfa), Epogen® (epoetin alfa), Mircera® (methoxy polyethylene glycol-epoetin beta [MPG-epoetin beta]), Procrit® (epoetin alfa), and Retacrit™ (epoetin alfa). Applicable Procedure Codes: J0881, J0882, J0885, J0887, J0888, Q4081, Q5105, Q5106.
Last Published 01.01.2023
Effective Date: 01.01.2023 – This policy addresses the use of erythropoiesis-stimulating agents (ESAs), including Aranesp® (darbepoetin alfa), Epogen® (epoetin alfa), Mircera® (methoxy polyethylene glycol-epoetin beta [MPG-epoetin beta]), Procrit® (epoetin alfa), and Retacrit™ (epoetin alfa). Applicable Procedure Codes: J0881, J0882, J0885, J0887, J0888, Q4081, Q5105, Q5106.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of erythropoiesis-stimulating agents (ESAs), including Aranesp® (darbepoetin alfa), Epogen® (epoetin alfa), Mircera® (methoxy polyethylene glycol-epoetin beta [MPG-epoetin beta]), Procrit® (epoetin alfa), and Retacrit™ (epoetin alfa). Applicable Procedure Codes: J0881, J0882, J0885, J0887, J0888, Q4081, Q5105, Q5106.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of erythropoiesis-stimulating agents (ESAs), including Aranesp® (darbepoetin alfa), Epogen® (epoetin alfa), Mircera® (methoxy polyethylene glycol-epoetin beta [MPG-epoetin beta]), Procrit® (epoetin alfa), and Retacrit™ (epoetin alfa). Applicable Procedure Codes: J0881, J0882, J0885, J0887, J0888, Q4081, Q5105, Q5106.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of erythropoiesis-stimulating agents (ESAs), including Aranesp® (darbepoetin alfa), Epogen® (epoetin alfa), Mircera® (methoxy polyethylene glycol-epoetin beta [MPG-epoetin beta]), Procrit® (epoetin alfa), and Retacrit™ (epoetin alfa). Applicable Procedure Codes: J0881, J0882, J0885, J0887, J0888, Q4081, Q5105, Q5106.
Last Published 04.02.2024
This policy is intended to address Evaluation and Management (E/M) services reported using Current Procedural Terminology (CPT®) codes 99201-99350.
Last Published 02.28.2024
This policy is intended to address Evaluation and Management (E/M) services. The E/M coding section of the CPT® book is divided into broad categories with further sub-categories which describe various E/M service classifications. The classification of the E/M service is important because the nature of the work varies by type of service, place of service, the patient’s medical status, and other code criteria, along with the amount of provider work and documentation required. The key components appear in the descriptors for most basic E/M codes and many code categories describe increasing levels of complexity.
Last Published 04.01.2024
The E/M coding section of the CPT® book is divided into broad categories with further sub-categories which describe various E/M service classifications. The classification of the E/M service is important because the nature of the work varies by type of service, place of service, the patient’s medical status, and other code criteria, along with the amount of provider work and documentation required.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Evenity® (Romosozumab-Aqqg) for the treatment of osteoporosis in postmenopausal patients at high risk for fracture. Applicable Procedure Code: J3111.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Evenity® (romosozumab-aqqg) for the treatment of osteoporosis in postmenopausal patients at high risk for fracture. Applicable Procedure Code: J3111.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Evenity® (romosozumab- aqqg) for the treatment of osteoporosis in postmenopausal patients at high risk for fracture. Applicable Procedures Code: J3111.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Evenity® (romosozumab- aqqg) for the treatment of osteoporosis in postmenopausal patients at high risk for fracture. Applicable Procedures Code: J3111.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Evkeeza® (evinacumab-dgnb) for the treatment of homozygous familial hypercholesterolemia (HoFH). Applicable Procedure Code: J1305.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses the use of Evkeeza® (evinacumab-dgnb) for the treatment of homozygous familial hypercholesterolemia (HoFH). Applicable Procedure Code: J1305.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Evkeeza® (evinacumab-dgnb) for the treatment of homozygous familial hypercholesterolemia (HoFH). Applicable Procedure Code: J1305.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Exondys 51® (eteplirsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1428.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Exondys 51® (eteplirsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1428.
Last Published 09.01.2023
Effective Date: 10.01.2023 – This policy addresses the use of Exondys 51® (eteplirsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1428.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses the use of Exondys 51® (eteplirsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1428.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Exondys 51® (eteplirsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1428.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Exondys 51® (eteplirsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1428.
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses experimental and/or investigational procedures, items, treatments, studies, tests, drugs, and equipment.
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses experimental and/or investigational procedures, items, treatments, studies, tests, drugs, and equipment.
Last Published 06.01.2024
This policy addresses experimental procedures and items, investigational devices, and clinical trials.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses extracorporeal shock wave therapy (ESWT) for musculoskeletal conditions and soft tissue wounds. Applicable Procedure Codes: 0101T, 0102T, 0512T, 0513T, 28890.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses extracorporeal shock wave therapy (ESWT) for musculoskeletal and soft tissue conditions. Applicable Procedure Codes: 0101T, 0102T, 0512T, 0513T, 28890.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses extracorporeal shock wave therapy (ESWT) for musculoskeletal and soft tissue conditions. Applicable Procedure Codes: 0101T, 0102T, 0512T, 0513T, 28890.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses extracorporeal shock wave therapy (ESWT) for musculoskeletal and soft tissue conditions. Applicable Procedure Codes: 0101T, 0102T, 0512T, 0513T, 28890.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses extracorporeal shock wave therapy (ESWT) for musculoskeletal and soft tissue conditions. Applicable Procedure Codes: 0101T, 0102T, 0512T, 0513T, 28890.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses extracorporeal shock wave therapy (ESWT) for musculoskeletal and soft tissue conditions. Applicable Procedure Codes: 0101T, 0102T, 0512T, 0513T, 28890.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses extracorporeal shock wave therapy (ESWT) for musculoskeletal and soft tissue conditions. Applicable Procedure Codes: 0101T, 0102T, 0512T, 0513T, 28890.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses extracorporeal shock wave therapy (ESWT) for musculoskeletal and soft tissue conditions. Applicable Procedure Codes: 0101T, 0102T, 0512T, 0513T, 28890.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses extracorporeal shock wave therapy (ESWT) for musculoskeletal and soft tissue conditions. Applicable Procedure Codes: 0101T, 0102T, 0512T, 0513T, 28890.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses facet joint injections/medial branch blocks for spinal pain. Applicable Procedure Codes: 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 64490, 64491, 64492, 64493, 64494, 64495.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses facet joint injections/medial branch blocks for spinal pain. Applicable Procedure Codes: 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 64490, 64491, 64492, 64493, 64494, 64495.
Last Published 09.01.2023
Effective Date: 11.01.2023 – This policy addresses facet joint injections/medial branch blocks for spinal pain. Applicable Procedure Codes: 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 64490, 64491, 64492, 64493, 64494, 64495.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses facet joint injections/medial branch blocks for spinal pain. Applicable Procedure Codes: 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 64490, 64491, 64492, 64493, 64494, 64495.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses facet joint injections/medial branch blocks for spinal pain. Applicable Procedure Codes: 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 64490, 64491, 64492, 64493, 64494, 64495.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses facet joint injections/medial branch blocks for spinal pain. Applicable Procedure Codes: 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 64490, 64491, 64492, 64493, 64494, 64495.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses facet joint injections/medial branch blocks for spinal pain. Applicable Procedure Codes: 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 64490, 64491, 64492, 64493, 64494, 64495.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses facet joint injections/medial branch blocks for spinal pain. Applicable Procedure Codes: 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 64490, 64491, 64492, 64493, 64494, 64495.
Last Published 11.23.2022
This policy addresses Form Locators (FLs) on the UB-04 and the required information for each field. If the information submitted is missing, incomplete, or invalid, the claim will be denied.
Last Published 04.14.2024
The uniform bill known as the UB-04, also called the CMS-1450, is used by Medicare and many major third-party payers for billing facility services.
Last Published 05.24.2024
The uniform bill known as the UB-04, also called the CMS-1450, is used by Medicare and many major third-party payers for billing facility services. F7007
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses birth control and contraception methods.
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses birth control and contraception methods.
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses infertility services.
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses infertility services.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses fecal measurement of calprotectin. Applicable Procedure Code: 83993.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses fecal microbiota transplantation (FMT) via enema for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: 0780T, 44705, G0455.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses fecal microbiota transplantation. Applicable Procedure Codes: 0780T, 44705, G0455.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses fecal microbiota transplantation. Applicable Procedure Codes: 0780T, 44705, G0455.
Last Published 06.01.2023
Effective Date: 09.01.2023 – This policy addresses fecal microbiota transplantation (FMT) via enema for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: 0780T, 44705, G0455.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses fecal microbiota transplantation (FMT) via enema for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: 0780T, 44705, G0455.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses fecal microbiota transplantation (FMT) via enema for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: 0780T, 44705, G0455.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses fecal microbiota transplantation (FMT) via enema for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: 0780T, 44705, G0455.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses fecal microbiota transplantation (FMT) via enema for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: 0780T, 44705, G0455.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses fecal microbiota transplantation (FMT) via enema for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: 0780T, 44705, G0455.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses fecal microbiota transplantation (FMT) via enema for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: 0780T, 44705, G0455.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses fecal microbiota transplantation (FMT) via enema for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: 0780T, 44705, G0455.
Last Published 06.01.2023
Effective Date: 09.01.2023 – This policy addresses fecal microbiota transplantation (FMT) via enema for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: 0780T, 44705, G0455.
Last Published 05.03.2024
This guideline provides an evidence-based approach to infertility management, infertility surgery, and the use of single embryo transfer in addition to describing the limitations of and recommendations for infertility treatment.
Last Published 02.01.2024
Effective Date: 12.01.2023 – This policy addresses fixed partial dentures (including provisional FPD) and repair, precision attachments, connector bar, and stress breaker.
Last Published 07.01.2022
Effective Date: 07.01.2022 – This policy addresses follow-up care when rendered in an emergency room (ER) site of service/setting.
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses routine foot care, foot examination, and other podiatry services.
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses routine foot care, foot examination, and other podiatry services.
Last Published 02.01.2024
When Grouping services, the place of service, procedure code, charges, and individual provider for each line must be identical for that service line. Grouping is allowed only for identical services on consecutive days. In those instances where Grouping of services applies, the number of units submitted should be equally divisible by the number of days indicated in the 'from' and 'to' dates reported.
Last Published 11.23.2022
When Grouping services, the place of service, procedure code, charges, and individual provider for each line must beidentical for that service line.
Last Published 02.01.2024
Effective Date: 12.01.2023 – This policy addresses full mouth debridement. Applicable Procedure Code: D4355.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses functional endoscopic sinus surgery (FESS). Applicable Procedure Codes: 31240, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31287, 31288.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses functional endoscopic sinus surgery (FESS). Applicable Procedure Codes: 31240, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31287, 31288.
Last Published 09.01.2023
Effective Date: 11.01.2023 – This policy addresses functional endoscopic sinus surgery (FESS). Applicable Procedure Codes: 31240, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31287, 31288.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses functional endoscopic sinus surgery (FESS). Applicable Procedure Codes: 31240, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31287, 31288.
Last Published 09.01.2023
Effective Date: 11.01.2023 – This policy addresses functional endoscopic sinus surgery (FESS). Applicable Procedure Codes: 31240, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31287, 31288.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses functional endoscopic sinus surgery (FESS). Applicable Procedure Codes: 31240, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31287, 31288.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses functional endoscopic sinus surgery (FESS). Applicable Procedure Codes: 31240, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31287, 31288.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses functional endoscopic sinus surgery (FESS). Applicable Procedure Codes: 31240, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31287, 31288.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses functional endoscopic sinus surgery (FESS). Applicable Procedure Codes: 31240, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31287, 31288.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses functional endoscopic sinus surgery (FESS). Applicable Procedure Codes: 31240, 31253, 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31287, 31288.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Gamifant® (emapalumab-lzsg) for the treatment of primary and secondary hemophagocytic lymphohistiocytosis (HLH). Applicable Procedure Code: J9210.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Gamifant® (emapalumab-lzsg) for the treatment of primary and secondary hemophagocytic lymphohistiocytosis (HLH). Applicable Procedure Code: J9210.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Gamifant® (emapalumab-lzsg) for the treatment of primary and secondary hemophagocytic lymphohistiocytosis (HLH). Applicable Procedure Code: J9210.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Gamifant® (emapalumab-lzsg) for the treatment of primary and secondary hemophagocytic lymphohistiocytosis (HLH). Applicable Procedure Code: J9210.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Gamifant® (emapalumab-lzsg) for the treatment of primary and secondary hemophagocytic lymphohistiocytosis (HLH). Applicable Procedure Code: J9210.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Gamifant® (emapalumab-lzsg) for the treatment of primary and secondary hemophagocytic lymphohistiocytosis (HLH). Applicable Procedure Code: J9210.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses gastric electrical stimulation therapy; manometry, sensation, tone, and compliance testing; defecography; and electrogastrography/electroenterography. Applicable Procedure Codes: 0779T, 43647, 43648, 43881, 43882, 64590, 64595, 72195, 72196, 72197, 76496, 91117, 91120, 91122, 91132, 91133, A9286, A9900, A9999, E1399.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses gastric electrical stimulation therapy; manometry, sensation, tone, and compliance testing; defecography; and electrogastrography/electroenterography. Applicable Procedure Codes: 64590, 64595, 72195, 72196, 72197, 76496, 91117, 91120, 91122, 91132, 91133, A9286, A9900, A9999, E1399.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses gastric electrical stimulation therapy; manometry, sensation, tone, and compliance testing; defecography; and electrogastrography/electroenterography. Applicable Procedure Codes: 0779T, 43647, 43648, 43881, 43882, 64590, 64595, 72195, 72196, 72197, 76496, 91117, 91120, 91122, 91132, 91133, A9286, A9900, A9999, E1399.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses gastric electrical stimulation therapy; manometry, sensation, tone, and compliance testing; defecography; and electrogastrography/electroenterography. Applicable Procedure Codes: 0779T, 43647, 43648, 43881, 43882, 64590, 64595, 72195, 72196, 72197, 76496, 91117, 91120, 91122, 91132, 91133, A9286, A9900, A9999, E1399.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses gastric electrical stimulation therapy; manometry, sensation, tone, and compliance testing; defecography; and electrogastrography/electroenterography. Applicable Procedure Codes: 0779T, 43647, 43648, 43881, 43882, 64590, 64595, 72195, 72196, 72197, 76496, 91117, 91120, 91122, 91132, 91133, A9286, A9900, A9999, E1399.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses gastric electrical stimulation therapy; manometry, sensation, tone, and compliance testing; defecography; and electrogastrography/electroenterography. Applicable Procedure Codes: 0779T, 43647, 43648, 43881, 43882, 64590, 64595, 72195, 72196, 72197, 76496, 91117, 91120, 91122, 91132, 91133, A9286, A9900, A9999, E1399.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses gastric electrical stimulation therapy; manometry, sensation, tone, and compliance testing; defecography; and electrogastrography/electroenterography. Applicable Procedure Codes: 0779T, 43647, 43648, 43881, 43882, 64590, 64595, 72195, 72196, 72197, 76496, 91117, 91120, 91122, 91132, 91133, A9286, A9900, A9999, E1399.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses gastric electrical stimulation therapy; manometry, sensation, tone, and compliance testing; defecography; and electrogastrography/electroenterography. Applicable Procedure Codes: 0779T, 43647, 43648, 43881, 43882, 64590, 64595, 72195, 72196, 72197, 76496, 91117, 91120, 91122, 91132, 91133, A9286, A9900, A9999, E1399.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses multiplex polymerase chain reaction (PCR) panel testing of gastrointestinal pathogens. Applicable Procedure Codes: 0369U, 87505, 87506, 87507.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses multiplex polymerase chain reaction (PCR) panel testing of gastrointestinal pathogens. Applicable Procedure Codes: 0369U, 87505, 87506, 87507.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses multiplex polymerase chain reaction (PCR) panel testing of gastrointestinal pathogens. Applicable Procedure Codes: 0369U, 87505, 87506, 87507.
Last Published 09.01.2023
Effective Date: 11.01.2023 – This policy addresses multiplex polymerase chain reaction (PCR) panel testing of gastrointestinal pathogens. Applicable Procedure Codes: 87505, 87506, 87507.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses multiplex polymerase chain reaction (PCR) panel testing of gastrointestinal pathogens. Applicable Procedure Codes: 87505, 87506, 87507.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses multiplex polymerase chain reaction (PCR) panel testing of gastrointestinal pathogens. Applicable Procedure Codes: 0369U, 87505, 87506, 87507.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses multiplex polymerase chain reaction (PCR) panel testing of gastrointestinal pathogens. Applicable Procedure Codes: 0369U, 87505, 87506, 87507.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses multiplex polymerase chain reaction (PCR) panel testing of gastrointestinal pathogens. Applicable Procedure Codes: 0369U, 87505, 87506, 87507.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses multiplex polymerase chain reaction (PCR) panel testing of gastrointestinal pathogens. Applicable Procedure Codes: 87505, 87506, 87507.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses multiplex polymerase chain reaction (PCR) panel testing of gastrointestinal pathogens. Applicable Procedure Codes: 87505, 87506, 87507.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses multiplex polymerase chain reaction (PCR) panel testing of gastrointestinal pathogens. Applicable Procedure Codes: 0369U, 87505, 87506, 87507.
Last Published 01.01.2024
Effective 01.01.2024 – This policy addresses surgical and non-surgical treatment for gender dysphoria.
Last Published 01.01.2024
Effective 01.01.2024 – This policy addresses gender dysphoria (gender identity disorder) treatment.
Last Published 01.01.2024
Effective 01.01.2024 – This policy addresses gender dysphoria (gender identity disorder) treatment.
Last Published 06.01.2024
This policy addresses gender reassignment surgery for members with gender dysphoria.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses gender dysphoria treatment, including surgical treatment and certain ancillary procedures.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses gender dysphoria treatment, including surgical treatment and certain ancillary procedures.
Last Published 06.01.2024
Effective Date: 05.01.2024 – This policy addresses gender dysphoria treatment, including surgical treatment and certain ancillary procedures.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses gender dysphoria treatment, including surgical treatment and certain ancillary procedures.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses gender dysphoria treatment, including surgical treatment and certain ancillary procedures.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses gender dysphoria treatment, including surgical treatment and certain ancillary procedures.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses gender dysphoria treatment, including surgical treatment and certain ancillary procedures.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses gender dysphoria treatment, including surgical treatment and certain ancillary procedures.
Last Published 12.01.2023
Effective Date: 12.01.23 – This policy addresses the use of Oncotype Dx Breast and EndoPredict for making treatment decisions regarding adjuvant chemotherapy in individuals with non-metastatic breast cancer. Applicable Procedure Codes: 81519, 81522.
Last Published 05.06.2024
This guideline contains general information, indications, and special considerations for the administration of ex vivo gene therapy.
Last Published 02.01.2024
Effective Date: 10.01.2023 – This policy addresses sedation for dentistry and local anesthesia, including nitrous oxide, intravenous moderate/conscious sedation, non-intravenous sedation, deep sedation/general anesthesia, and nerve blocks. Applicable Procedure Codes: D9210, D9211, D9212, D9215, D9219, D9222, D9223, D9230, D9239, D9243, D9248.
Last Published 09.01.2023
Effective Date: 11.01.2023 – This policy addresses genetic testing for cardiac disease. Applicable Procedure Codes: 0237U, 0401U 81410, 81411, 81413, 81414, 81439, 81479, 81493.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses genetic testing for cardiac disease. Applicable Procedure Codes: 0237U, 0401U, 0439U, 0440U, 81410, 81411, 81413, 81414, 81439, 81479, 81493.
Last Published 06.01.2024
This policy addresses genetic testing for hereditary cardiovascular disease. Applicable Procedure Codes: 0119U, 0237U, 81161, 81410, 81411, 81413, 81414, 81415, 81416, 81417, 81439, 81442.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses hereditary breast and ovarian cancer (BRCA1, BRCA2) testing and multi-gene hereditary cancer panel testing. Applicable Procedure Codes: 0101U, 0102U, 0103U, 0129U, 0130U, 0131U, 0132U, 0133U, 0134U, 0135U, 0138U, 0162U, 0238U, 81162, 81163, 81164, 81432, 81433, 81435, 81436, 81437, 81438, 81441, 81479.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses hereditary breast and ovarian cancer (BRCA1, BRCA2) testing and multi-gene hereditary cancer panel testing. Applicable Procedure Codes: 0101U, 0102U, 0103U, 0129U, 0130U, 0131U, 0132U, 0133U, 0134U, 0135U, 0138U, 0162U, 0238U, 81162, 81163, 81164, 81432, 81433, 81435, 81436, 81437, 81438.
Last Published 09.01.2023
Effective Date: 11.01.2023 – This policy addresses hereditary breast and ovarian cancer (BRCA1, BRCA2) testing and multi-gene hereditary cancer panel testing. Applicable Procedure Codes: 0101U, 0102U, 0103U, 0129U, 0130U 0131U, 0132U, 0133U, 0134U, 0135U, 0138U, 0162U, 0238U, 81162, 81163, 81164, 81432, 81433, 81435, 81436, 81441, 81437, 81438, 81441, 81479.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses hereditary breast and ovarian cancer (BRCA1, BRCA2) testing and multi-gene hereditary cancer panel testing. Applicable Procedure Codes: 0101U, 0102U, 0103U, 0129U, 0130U 0131U, 0132U, 0133U, 0134U, 0135U, 0138U, 0162U, 0238U, 81162, 81163, 81164, 81432, 81433, 81435, 81436, 81437, 81438, 81441, 81479.
Last Published 06.01.2024
This policy addresses genetic testing for hereditary cancer. Applicable Procedure Codes: 0101U, 0102U, 0103U, 0129U, 0130U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0158U, 0159U, 0160U, 0161U, 0162U, 0238U, 81162, 81163, 81164, 81165, 81166
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses multi-gene panel testing for the diagnosis of neuromuscular disorders. Applicable Procedure Codes: 0216U, 0217U, 0417U, 81440, 81448, 81460, 81465, 81479.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses multi-gene panel testing for the diagnosis of neuromuscular disorders. Applicable Procedure Codes: 0216U, 0217U, 0417U, 81440, 81460, 81465, 81479.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses multi-gene panel testing for the diagnosis of neuromuscular disorders. Applicable Procedure Codes: 0216U, 0217U, 0417U, 81440, 81448, 81460, 81465, 81479.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses multi-gene panel testing for the diagnosis of neuromuscular disorders. Applicable Procedure Codes: 0216U, 0217U, 0417U, 81440, 81448, 81460, 81465, 81479.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses multi-gene panel testing for the diagnosis of neuromuscular disorders. Applicable Procedure Codes: 0216U, 0217U, 81440, 81460, 81465, 81479.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses multi-gene panel testing for the diagnosis of neuromuscular disorders. Applicable Procedure Codes: 0216U, 0217U, 81440, 81448, 81460, 81465, 81479.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses multi-gene panel testing for the diagnosis of neuromuscular disorders. Applicable Procedure Codes: 0216U, 0217U, 81440, 81448, 81460, 81465, 81479.
Last Published 09.01.2023
Effective Date: 11.01.2023 – This policy addresses genetic testing for susceptibility to breast and ovarian cancer. Applicable Procedure Code: 81162.
Last Published 12.01.2023
Effective Date: 12.01.23 – This policy addresses genetic testing for susceptibility to breast and ovarian cancer. Applicable Procedure Codes: 81162
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses genetic testing and counseling.
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses genetic testing and counseling.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses genitourinary pathogen nucleic acid detection panel testing to evaluate symptomatic women for vaginitis. Applicable Procedure Codes: 0068U, 0330U, 0352U, 87480, 81513, 81514, 87481, 87482, 87510, 87511, 87512, 87660, 87661, 87797, 87798, 87799, 87800, 87801.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Givlaari® (givosiran) for the treatment of acute hepatic porphyrias. Applicable Procedure Code: J0223.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Givlaari® (givosiran) for the treatment of acute hepatic porphyrias. Applicable Procedure Code: J0223.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Givlaari® (givosiran) for the treatment of acute hepatic porphyrias. Applicable Procedure Code: J0223.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Givlaari® (givosiran) for the treatment of acute hepatic porphyrias. Applicable Procedure Code: J0223.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Givlaari® (givosiran) for the treatment of acute hepatic porphyrias. Applicable Procedure Code: J0223.
Last Published 06.01.2024
Effective Date: 10.01.2023 – This policy addresses glaucoma drainage devices/stents and canaloplasty. Applicable Procedure Codes: 0253T, 0449T, 0450T, 0474T, 0671T, 65820, 66174, 66175, 66179, 66180, 66183, 66989, 66991, C1889, L8612.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses glaucoma drainage devices/stents, canaloplasty, and gonioscopy-assisted transluminal trabeculotomy. Applicable Procedure Codes: 0253T, 0449T, 0450T, 0474T, 0671T, 65820, 66174, 66175, 66179, 66180, 66183, 66989, 66991, C1889, L8612.
Last Published 06.01.2024
Effective Date: 10.01.2023 – This policy addresses glaucoma drainage devices/stents, canaloplasty, and gonioscopy-assisted transluminal trabeculotomy. Applicable Procedure Codes: 0253T, 0449T, 0450T, 0474T, 0671T, 65820, 66174, 66175, 66179, 66180, 66183, 66989, 66991, C1889, L8612.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses glaucoma drainage devices/stents, canaloplasty, and gonioscopy-assisted transluminal trabeculotomy. Applicable Procedure Codes: 0253T, 0449T, 0450T, 0474T, 0671T, 65820, 66174, 66175, 66179, 66180, 66183 , 66989, 66991, C1889, L8612.
Last Published 06.01.2024
Effective Date: 09.01.2023 – This policy addresses glaucoma drainage devices/stents, canaloplasty, and gonioscopy-assisted transluminal trabeculotomy. Applicable Procedure Codes: 0253T, 0449T, 0450T, 0474T, 0671T, 65820, 66174, 66175, 66179, 66180, 66183, 66989, 66991, C1889, L8612.
Last Published 06.01.2024
Effective Date: 09.01.2023 – This policy addresses glaucoma drainage devices/stents, canaloplasty, and gonioscopy-assisted transluminal trabeculotomy. Applicable Procedure Codes: 0253T, 0449T, 0450T, 0474T, 0671T, 65820, 66174, 66175, 66179, 66180, 66183, 66989, 66991, C1889, L8612.
Last Published 06.01.2024
Effective Date: 10.01.2023 – This policy addresses glaucoma drainage devices/stents, canaloplasty, and gonioscopy-assisted transluminal trabeculotomy. Applicable Procedure Codes: 0253T, 0449T, 0450T, 0474T, 0671T, 65820, 66174, 66175, 66179, 66180, 66183, 66989, 66991, C1889, L8612.
Last Published 04.01.2024
The Global Period assignment or Global Days Value is the time frame that applies to certain procedures subject to a Global Surgical Package concept whereby all necessary services normally furnished by a physician (before, during and after the procedure) are included in the reimbursement for the procedure performed. Modifiers should be used as appropriate to indicate services that are not part of the Global Surgical Package. 2023R9013
Last Published 02.14.2024
The Global Period assignment or Global Days Value is the time frame that applies to certain procedures subject to a Global Surgical Package concept whereby all necessary services normally furnished by a physician (before, during and after the procedure) are included in the reimbursement for the procedure performed.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses gonadotropin releasing hormone analog (GnRH analog) drug products. Applicable Procedure Codes: J1950, J1951, J1952, J1954, J3315, J3316, J9155, J9202, J9217, J9225, J9226.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses gonadotropin releasing hormone analog (GnRH analog) drug products. Applicable Procedure Codes: J1950, J1951, J1952, J3315, J3316, J9155, J9202, J9217, J9225, J9226.
Last Published 03.01.2024
Effective Date: 11.01.2023 – This policy addresses gonadotropin releasing hormone analog (GnRH analog) drug products. Applicable Procedure Codes: J1950, J1951, J1952, J1954, J3315, J3316, J9155, J9202, J9217, J9226.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses gonadotropin releasing hormone analog (GnRH analog) drug products. Applicable Procedure Codes: J1950, J1951, J1952, J1954, J3315, J3316, J9155, J9202, J9217, J9226.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses mastectomy or suction lipectomy for the treatment of benign gynecomastia. Applicable Procedure Code: 19300.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses mastectomy or suction lipectomy for the treatment of benign gynecomastia. Applicable Procedure Code: 19300.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses mastectomy or suction lipectomy for the treatment of benign gynecomastia. Applicable Procedure Code: 19300.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses mastectomy or suction lipectomy for the treatment of benign gynecomastia. Applicable Procedure Code: 19300.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses mastectomy or suction lipectomy for the treatment of benign gynecomastia. Applicable Procedure Code: 19300.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses mastectomy or suction lipectomy for the treatment of benign gynecomastia. Applicable Procedure Code: 19300.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses surgical treatment of gynecomastia. Applicable Procedure Code: 19300.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses mastectomy or suction lipectomy for the treatment of benign gynecomastia. Applicable Procedure Code: 19300.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses mastectomy or suction lipectomy for the treatment of benign gynecomastia. Applicable Procedure Code: 19300.
Last Published 05.01.2023
Effective Date: 06.01.2023 – This policy addresses outpatient and inpatient habilitation services and outpatient rehabilitation services.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses outpatient habilitation, rehabilitation, and maintenance therapy.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses outpatient physical, occupational, and speech therapy.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses outpatient habilitation, rehabilitation, and maintenance therapy.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses outpatient habilitation, rehabilitation, and maintenance therapy.
Last Published 10.01.2023
Effective Date: 12.01.2023 – This policy addresses habilitation, rehabilitation, and maintenance services.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses habilitation, rehabilitation, and maintenance services.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses outpatient and inpatient habilitative services and outpatient rehabilitation services.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses outpatient and inpatient habilitation services and outpatient rehabilitation services.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses the medical necessity of certain elective procedures when performed in a hospital outpatient department.
Last Published 04.14.2024
This reimbursement policy describes how claims for Habilitative, and Rehabilitative Services should be reported using the appropriate Modifiers.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses outpatient habilitative services, including physical therapy, occupational therapy, post-cochlear implant aural therapy, cognitive habilitative therapy, manipulative treatment, and speech therapy.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses outpatient habilitative services, including physical therapy, occupational therapy, post-cochlear implant aural therapy, cognitive habilitative therapy, manipulative treatment, and speech therapy.
Last Published 06.01.2024
This policy addresses the use of Halaven® (eribulin mesylate). Applicable Procedure Code: J9179.
Last Published 06.01.2023
Effective Date: 06.01.2023 – This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems.
Last Published 02.01.2024
Effective Date: 04.01.2024 – This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses wearable, bone-anchored, and semi-implantable hearing aids and devices.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems.
Last Published 02.09.2024
This reimbursement policy describes how claims for Monaural Hearing Aids should be reported using the appropriate Anatomical Modifiers.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses wearable air conduction, bone-anchored, semi-implantable hearing aids (SEHA), intraoral bone conduction, and laser or light based hearing aids, and totally implanted middle ear hearing systems.
Last Published 06.01.2024
This policy addresses hearing services and devices, including hearing screening/examinations, hearing aids, auditory implants, and audiology services. Applicable Procedure Code: 69710, 69714, 69716, 69729, 69930, 92590, 92591, L7510, L8614, L8619, L8690, L8691, L8692, V5030, V5261.
Last Published 04.19.2024
This guideline outlines the stages of heart failure and describes a range of generally acceptable approaches for the diagnosis, management, and prevention of heart failure.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Hemgenix® (etranacogene dezaparvovec-drlb) for the treatment of hemophilia B. Applicable Procedure Code: J1411.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Hemgenix® (etranacogene dezaparvovec-drlb) for the treatment of hemophilia B. Applicable Procedure Codes: C9399, J3490, J3590.
Last Published 04.19.2024
This guideline outlines the diagnosis, management, and treatment of hemophilia.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses hepatitis screening. Applicable Procedure Codes: 86704, 86705, 86706, 86707, 86708, 86709, 86803, 86804, 87340, 87341, 87350, 87467, 87902, 87912, G0472, G0499.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses hepatitis screening. Applicable Procedure Codes: 86704, 86705, 86706, 86707, 86708, 86709, 86803, 86804, 87340, 87341, 87350, 87467, 87902, 87912, G0472, G0499.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses hepatitis screening. Applicable Procedure Codes: 86704, 86705, 86706, 86707, 86708, 86709, 86803, 86804, 87340, 87341, 87350, 87902, 87912, G0472, G0499.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses hepatitis screening. Applicable Procedure Codes: 86704, 86705, 86706, 86707, 86708, 86709, 86803, 86804, 87340, 87341, 87350, 87467, 87902, 87912, G0472, G0499.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses hepatitis screening. Applicable Procedure Codes: 86704, 86705, 86706, 86707, 86708, 86709, 86803, 86804, 87340, 87341, 87350, 87467, 87902, 87912, G0472, G0499.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses hepatitis screening. Applicable Procedure Codes: 86704, 86705, 86706, 86707 , 86708, 86709, 86803, 86804, 87340, 87341, 87350, 87467, 87902, 87912, G0472, G0499.
Last Published 11.01.2022
UnitedHealthcare Community Plan Policy Appendix
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses hepatitis screening. Applicable Procedure Codes: 86704, 86705, 86706, 86707, 86708, 86709, 86803, 86804, 87340, 87341, 87350, 87467, 87902, 87912, G0472, G0499.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses hepatitis screening. Applicable Procedure Codes: 86704, 86705, 86706, 86707, 86708, 86709, 86803, 86804, 87340, 87341, 87350, 87467, 87902, 87912, G0472, G0499.
Last Published 03.01.2024
Effective Date: 12.01.2023 – This policy addresses hepatitis screening. Applicable Procedure Codes: 86704, 86705, 86706, 86707, 86708, 86709, 86803, 86804, 87340, 87341, 87350, 87467, 87902, 87912, G0472, G0499.
Last Published 01.03.2023
Last Published 11.01.2023
Last Published 02.01.2024
Hepatitis Screening: Diagnosis Codes (for Louisiana Only)
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of C1 esterace inhibitors (human), C1 esterace inhibitors (recombinant), and plasma kallikrein inhibitors (human) for the treatment and prophlaxis of hereditary angioedema (HAE). Applicable Procedure Codes: J0596, J0597, J0598, J1290.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of C1 esterace inhibitors (human), C1 esterace inhibitors (recombinant), and plasma kallikrein inhibitors (human) for the treatment and prophlaxis of hereditary angioedema (HAE). Applicable Procedure Codes: J0596, J0597, J0598, J1290.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of C1 esterace inhibitors (human), C1 esterace inhibitors (recombinant), and plasma kallikrein inhibitors (human) for the treatment and prophlaxis of hereditary angioedema (HAE). Applicable Procedure Codes: J0596, J0597, J0598, J1290.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of C1 esterace inhibitors (human), C1 esterace inhibitors (recombinant), and plasma kallikrein inhibitors (human) for the treatment and prophylaxis of hereditary angioedema (HAE). Applicable Procedure Codes: J0596, J0597, J0598, J1290.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home health care services.
Last Published 11.01.2023
Effective 11.01.2023 – This policy addresses home health care visits and related services.
Last Published 11.01.2023
Effective 11.01.2023 – This policy addresses home health care visits and related services.
Last Published 06.01.2024
This policy addresses home health, skilled care, and related services and supplies. Applicable Procedure Codes: 97535, 99503, 99505, 99509, 99601, G0151, G0152, G0153, G0155, G0156, G0157, G0158, G0159, G0160, G0161, G0162, G0249, G0270, G0299, G0300, G0493, G0494, G0495, G0496, G2168, G2169.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses home health, skilled, and custodial care services.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home health, skilled, and custodial care services.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses home health, skilled, and custodial care services.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses home health, skilled, and custodial care services.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home health, skilled, and custodial care services.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home health, skilled, and custodial care services.
Last Published 09.01.2023
Effective Date: 11.01.2023 – This policy addresses home health, skilled, and custodial care services.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home health, skilled, and custodial care services.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses skilled care and custodial care services. Applicable Procedure Codes: 99500, 99501, 99502, 99503, 99504, 99505, 99506, 99507, 99511, 99512, 99601, 99602, G0068, G0069, G0070, G0088, G0089, G0090, G0153, G0155, G0156, G0157, G0158, G0159, G0160, G0161, G0162, G0299, G0300, G0320, G0321, G0322, G0490, G0493, G0494, G0495, G0496, G2168, G2169, H1004, S5035, S5036, S5108, S5109, S5110, S5111, S5115, S5116, S5180, S5181, S5497, S5498, S5501, S5502, S5517, S5518, S5520, S5521, S5522, S5523, S9061, S9097, S9098, S9122, S9123, S9124, S9127, S9208, S9209, S9211, S9212, S9213, S9214, S9325, S9326, S9327, S9328, S9329, S9330, S9331, S9335, S9336, S9338, S9339, S9340, S9341, S9342, S9343, S9345, S9346, S9347, S9348, S9351, S9353, S9355, S9357, S9359, S9361, S9363, S9364, S9365, S9366, S9367, S9368, S9370, S9372, S9373, S9374, S9375, S9376, S9377, S9379, S9474, S9490, S9494, S9497, S9500, S9501, S9502, S9503, S9504, S9537, S9538, S9542, S9559, S9560, S9562, S9590, T1001, T1002, T1003, T1004, T1005, T1021, T1022, T1028, T1030, T1031, T1502.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home hemodialysis (HHD). Applicable Procedure Codes: 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 90989, 90993, 99512, S9335.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home hemodialysis (HHD). Applicable Procedure Codes: 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 90989, 90993, 99512, S9335.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home hemodialysis (HHD). Applicable Procedure Codes: 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 90989, 90993, 99512, S9335.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses home hemodialysis (HHD). Applicable Procedure Codes: 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 90989, 90993, 99512, S9335.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home hemodialysis (HHD). Applicable Procedure Codes: 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 90989, 90993, 99512, S9335.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home hemodialysis (HHD). Applicable Procedure Codes: 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 90989, 90993, 99512, S9335.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home hemodialysis (HHD). Applicable Procedure Codes: 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 90989, 90993, 99512, S9335.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses home traction therapy. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home traction therapy. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses home traction therapy. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses home traction therapy. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home traction therapy. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses home traction therapy. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home traction therapy. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home traction therapy. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses home traction therapy. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses home traction therapy. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses home traction therapy. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses home traction therapy. Applicable Procedure Codes: E0830, E0840, E0849, E0850, E0855, E0856, E0860, E0941.
Last Published 11.01.2023
Hospital Acquired Conditions (HAC) are serious conditions that patients get during an inpatient hospital stay. If hospitals follow proper procedures, patients are less likely to get these conditions. UnitedHealthcare Medicare Advantage doesn't pay for any of these conditions, and patients can't be billed for them, if acquired while in the hospital. UnitedHealthcare Medicare Advantage will only pay for these conditions if they were present on admission to the hospital.
Last Published 04.14.2024
This policy addresses reimbursement related to services included as part of an ambulance transportation service and ambulance modifier usage. For purposes of this policy, “provider” is used to reference a hospital-based ambulance provider. A “supplier” is defined as any ambulance service that is not institutionally based. R5018
Last Published 04.18.2023
Hospitals wishing to participate in a UnitedHealthcare commercial network as a reference laboratory may apply with UnitedHealthcare to be credentialed and contracted as a reference laboratory.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses outpatient and acute inpatient hospital services and supplies.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses outpatient and acute inpatient hospital services and supplies.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses hospital services for observation versus inpatient level of care.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses hospital services for observation versus inpatient level of care.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses hospital services for observation versus inpatient level of care.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses hospital services for observation versus inpatient level of care.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses hospital services for observation versus inpatient level of care.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses hospital services for observation versus inpatient level of care.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses hospital services for observation versus inpatient level of care.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses hospital services for observation versus inpatient level of care.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses hospital services for observation versus inpatient level of care.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses hospital services for observation versus inpatient level of care.
Last Published 01.01.2024
Effective Date: 11.01.2023 – This policy addresses hospital services for observation versus inpatient level of care.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses hospital services for observation versus inpatient level of care.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses hospital services for observation versus inpatient level of care.
Last Published 06.01.2024
This policy addresses inpatient and outpatient hospital services, outpatient observation services, religious nonmedical health care institutions (RNHCIs), long term care hospitals (LTCH), never events, emergency and urgently needed services, post-stabilization care services, follow-up care services, and ambulance services.
Last Published 04.19.2024
These guidelines outline the management of adults and adolescents infected with HIV.
Last Published 04.19.2024
This clinical guideline addresses the prevention, detection, evaluation, and management of high blood pressure in adults.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses hysterectomy. Applicable Procedure Codes: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses hysterectomy. Applicable Procedure Codes: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses hysterectomy. Applicable Procedure Codes: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses hysterectomy. Applicable Procedure Codes: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573.
Last Published 02.01.2024
Effective Date: 04.01.2024 – This policy addresses hysterectomy. Applicable Procedure Codes: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses hysterectomy. Applicable Procedure Codes: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses hysterectomy. Applicable Procedure Codes: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses hysterectomy. Applicable Procedure Codes: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573.
Last Published 03.01.2024
Effective Date: 02.01.2024 – This policy addresses hysterectomy. Applicable Procedure Codes: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses hysterectomy. Applicable Procedure Codes: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses hysterectomy. Applicable Procedure Codes: 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Ilaris®. Applicable Procedure Code: J0638.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of Ilaris® (canakinumab). Applicable Procedure Code: J0638.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Ilaris® (canakinumab) for the treatment of cryopyrin-associated periodic syndromes (CAPS), tumor necrosis factor (TNF) receptor-associated periodic syndrome (TRAPS), hyperimmunoglobulin D (Hyper-IgD) syndrome (HIDS)/mevalonate kinase deficiency (MKD), familial mediterranean fever (FMF), Still’s disease, systemic juvenile idiopathic arthritis (SJIA) and gout flares. Applicable Procedure Code: J0638.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Ilaris® (canakinumab) for the treatment of cryopyrin-associated periodic syndromes (CAPS), tumor necrosis factor (TNF) receptor-associated periodic syndrome (TRAPS), hyperimmunoglobulin D (Hyper-IgD) syndrome (HIDS)/mevalonate kinase deficiency (MKD), familial mediterranean fever (FMF), Still’s disease, and systemic juvenile idiopathic arthritis (SJIA). Applicable Procedure Code: J0638.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of provider-administered Ilumya® (tildrakizumab-asmn) for the treatment of moderate to severe plaque psoriasis. Applicable Procedure Code: J3245.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of provider-administered Ilumya® (tildrakizumab-asmn) for the treatment of moderate to severe plaque psoriasis. Applicable Procedure Code: J3245.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of provider-administered Ilumya® (tildrakizumab-asmn) for the treatment of moderate to severe plaque psoriasis. Applicable Procedure Code: J3245.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of intravenous (IV) and subcutaneous (SC) immune globulin (IG) products. Applicable Procedure Codes: 90283, 90284, J1459, J1551, J1554, J1555, J1556, J1557, J1558, J1559, J1561, J1566, J1568, J1569, J1572, J1575, J1576, J1599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of intravenous (IV) and subcutaneous (SC) immune globulin (IG) products. Applicable Procedure Codes: 90283, 90284, J1459, J1551, J1554, J1555, J1556, J1557, J1558, J1559, J1561, J1566, J1568, J1569, J1572, J1575, J1599.
Last Published 06.01.2023
Effective Date: 07.01.2023 – This policy addresses the use of intravenous (IV) and subcutaneous (SC) immune globulin (IG) products. Applicable Procedure Codes: 90283, 90284, J1459, J1551, J1554, J1555, J1556, J1557, J1558, J1559, J1561, J1566, J1568, J1569, J1572, J1575, J1599.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses the use of intravenous (IV) and subcutaneous (SC) immune globulin (IG) products. Applicable Procedure Codes: 90283, 90284, J1459, J1551, J1554, J1555, J1556, J1557, J1558, J1559, J1561, J1566, J1568, J1569, J1572, J1575, J1576 J1599.
Last Published 06.01.2024
This policy addresses intravenous immune globulin (IVIG). Applicable Procedure Codes: C0972, J1459, J1554, J1556, J1557, J1561, J1566, J1568, J1569, J1572, J1599, Q2052.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses immunomodulator agents for inflammatory conditions. Applicable Procedure Codes: C9399, 96372, 96401, J0129, J0717, J1602, J2327, J3245, J3262, J3357, J3358, J3380. J3490, J3590.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses transarterial radioembolization (TARE) using yttrium-90 (90Y) microspheres for the treatment of malignant tumors. Applicable Procedure Codes: 37243, 79445, S2095.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses transarterial radioembolization (TARE) using yttrium-90 (90Y) microspheres for the treatment of malignant tumors. Applicable Procedure Codes: 37243, 79445, S2095.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses transarterial radioembolization (TARE) using yttrium-90 (90Y) microspheres for the treatment of malignant tumors. Applicable Procedure Codes: 37243, 79445, S2095.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses transarterial radioembolization (TARE) using yttrium-90 (90Y) microspheres for the treatment of malignant tumors. Applicable Procedure Codes: 37243, 79445, S2095.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses transarterial radioembolization (TARE) using yttrium-90 (90Y) microspheres for the treatment of malignant tumors. Applicable Procedure Codes: 37243, 79445, S2095.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses transarterial radioembolization (TARE) using yttrium-90 (90Y) microspheres for the treatment of malignant tumors. Applicable Procedure Codes: 37243, 79445, S2095.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses transarterial radioembolization (TARE) using yttrium-90 (90Y) microspheres for the treatment of malignant tumors. Applicable Procedure Codes: 37243, 79445, S2095.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses transarterial radioembolization (TARE) using yttrium-90 (90Y) microspheres for the treatment of malignant tumors. Applicable Procedure Codes: 37243, 79445, S2095.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses transarterial radioembolization (TARE) using yttrium-90 (90Y) microspheres for the treatment of malignant tumors. Applicable Procedure Codes: 37243, 79445, S2095.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses implanted electrical stimulator for spinal cord. Applicable Procedure Codes: 63650, 63655, 63685, 63688, L8679, L8680, L8682, L8685, L8686, L8687, L8688, L8695.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses implanted electrical stimulator for spinal cord. Applicable Procedure Codes: 63650, 63655, 63685, 63688, L8679, L8680, L8682, L8685, L8686, L8687, L8688, L8695.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses implanted electrical stimulators for spinal cord. Applicable Procedure Codes: 63650, 63655, 63685, 63688, L8679, L8680, L8682, L8685, L8686, L8687, L8688, L8695.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses implanted electrical stimulator for spinal cord. Applicable Procedure Codes: 63650, 63655, 63685, 63688, L8679, L8680, L8682, L8685, L8686, L8687, L8688, L8695.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses implanted electrical stimulator for spinal cord. Applicable Procedure Codes: 63650, 63655, 63685, 63688, L8679, L8680, L8682, L8685, L8686, L8687, L8688, L8695.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses implanted electrical stimulator for spinal cord. Applicable Procedure Codes: 63650, 63655, 63685, 63688, L8679, L8680, L8682, L8685, L8686, L8687, L8688, L8695.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses implanted electrical spinal cord and dorsal root ganglion (DRG) stimulation. Applicable Procedure Codes: 63650, 63655, 63685, 63688, C1767, C1778, C1816, C1820, C1822, C1823, C1883, C1897, L8679, L8680, L8682, L8685, L8686, L8687, L8688, L8695.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses implanted electrical spinal cord and dorsal root ganglion (DRG) stimulation. Applicable Procedure Codes: 63650, 63655, 63685, 63688, L8679, L8680, L8682, L8685, L8686, L8687, L8688, L8695.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses implanted electrical spinal cord and dorsal root ganglion (DRG) stimulation. Applicable Procedure Codes: 63650, 63655, 63685, 63688, L8679, L8680, L8682, L8685, L8686, L8687, L8688, L8695.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses implanted spinal drug delivery systems for the treatment of cancer-related pain, severe spasticity, and chronic non-malignant pain. Applicable Procedure Codes: 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 62350, 62351, 62360, 62361, 62362.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses implanted spinal drug delivery systems for the treatment of cancer-related pain, severe spasticity, and chronic non-malignant pain. Applicable Procedure Codes: 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 62350, 62351, 62360, 62361, 62362.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses implanted spinal drug delivery systems for the treatment of cancer-related pain, severe spasticity, and chronic non-malignant pain. Applicable Procedure Codes: 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 62350, 62351, 62360, 62361, 62362.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses laboratory testing/procedures that Oxford Network physicians may provide in their offices, including specimen handling and venipuncture.
Last Published 03.01.2024
Incident to a physician’s professional services means that the services or supplies are furnished as an integral, although incidental, part of the physician’s personal professional services in the course of diagnosis or treatment of an injury or illness. R9004
Last Published 11.23.2022
This policy identifies circumstances in which UnitedHealthcare Community Plan will reimburse suppliers for incontinence supplies and the maximum amount of supplies that will be reimbursed per month.
Last Published 04.01.2024
The term "increased procedural services" designates a service provided by a physician or other health care professional that is substantially greater than typically required for the procedure or service as defined in the Current Procedural Terminology (CPT®) book. Increased procedural services are reported by appending Modifier 22 to the usual procedure code. R0061 Flag: UNS
Last Published 04.16.2024
The term "increased procedural services" designates a service provided by a physician or other health care professional that is substantially greater than typically required for the procedure or service as defined in the Current Procedural Terminology (CPT®) book. Increased procedural services are reported by appending Modifier 22 to the usual procedure code. R0061
Last Published 01.03.2023
The term "increased procedural services" designates a service provided by a physician or other health care professional that is substantially greater than typically required for the procedure or service as defined in the Current Procedural Terminology (CPT®) book. Increased procedural services are reported by appending Modifier 22 to the usual procedure code.Procedures performed on neonates and infants up to a present body weight of 4 kg may involve significantly increased complexity and physician or other qualified health care professional work commonly associated with these patients, as defined in the CPT book. In these circumstances Modifier 63 may be appended to the usual procedure code, unless directed otherwise in the CPT book.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses services for infertility and fertility preservation.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses services for infertility and fertility preservation.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of infliximab products, including Avsola® (infliximab-axxq), Inflectra® (infliximab-dyyb), Remicade® (infliximab), and Renflexis® (infliximab-abda). Applicable Procedure Codes: J1745, Q5103, Q5104, Q5109, Q5121.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of inhaled nitric oxide (iNO) for treating term or near-term infants with hypoxic respiratory failure or echocardiographic evidence of persistent pulmonary hypertension of the newborn (PPHN). Applicable Procedure Code: 94799.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of inhaled nitric oxide (iNO) for treating term or near-term infants with hypoxic respiratory failure or echocardiographic evidence of persistent pulmonary hypertension of the newborn (PPHN). Applicable Procedure Code: 94799.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of inhaled nitric oxide (iNO) for treating term or near-term infants with hypoxic respiratory failure or echocardiographic evidence of persistent pulmonary hypertension of the newborn (PPHN). Applicable Procedure Code: 94799.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of inhaled nitric oxide (iNO) for treating term or near-term infants with hypoxic respiratory failure or echocardiographic evidence of persistent pulmonary hypertension of the newborn (PPHN). Applicable Procedure Code: 94799.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of inhaled nitric oxide (iNO) for treating term or near-term infants with hypoxic respiratory failure or echocardiographic evidence of persistent pulmonary hypertension of the newborn (PPHN). Applicable Procedure Code: 94799.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of inhaled nitric oxide (iNO) for treating term or near-term infants with hypoxic respiratory failure or echocardiographic evidence of persistent pulmonary hypertension of the newborn (PPHN). Applicable Procedure Code: 94799.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses dermal filler injections and injectable bulking agents. Applicable Procedure Codes: G0429, L8607, Q2026, Q2028.
Last Published 03.01.2024
Effective Date: 04.01.2024 – This policy addresses dermal filler injections and injectable bulking agents. Applicable Procedure Codes: G0429, L8607, Q2026, Q2028.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses dermal filler injections and injectable bulking agents. Applicable Procedure Codes: G0429, L8607, Q2026, Q2028.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses dermal filler injections and injectable bulking agents. Applicable Procedure Codes: G0429, L8607, Q2026, Q2028.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses dermal filler injections and injectable bulking agents. Applicable Procedure Codes: G0429, L8607, Q2026, Q2028.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses dermal filler injections and injectable bulking agents. Applicable Procedure Codes: G0429, L8607, Q2026, Q2028.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses dermal filler injections and injectable bulking agents. Applicable Procedure Codes: G0429, L8607, Q2026, Q2028.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses dermal filler injections and injectable bulking agents. Applicable Procedure Codes: G0429, L8607, Q2026, Q2028.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses dermal filler injections and injectable bulking agents. Applicable Procedure Codes: G0429, L8607, Q2026, Q2028.
Last Published 04.02.2024
Effective Date: 01.01.2024 – This policy addresses dermal filler injections and injectable bulking agents. Applicable Procedure Codes: G0429, L8607, Q2026, Q2028.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses dermal filler injections and injectable bulking agents. Applicable Procedure Codes: G0429, L8607, Q2026, Q2028.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses dermal filler injections and injectable bulking agents. Applicable Procedure Codes: G0429, L8607, Q2026, Q2028.
Last Published 04.01.2024
This policy describes reimbursement for therapeutic and diagnostic Injection services (CPT codes 96372-96379) when reported with evaluation and management (E/M) services. R0009 Flag: THIEM, THISD
Last Published 02.04.2024
This policy describes reimbursement for therapeutic and diagnostic Injection services (CPT codes 96372-96379) when reported with evaluation and management (E/M) services. This policy also describes reimbursement for Healthcare Common Procedure Coding System (HCPCS) supplies and/or drug codes when reported with Injection and Infusion services (CPT codes 96360-96379).
Last Published 02.25.2024
This policy describes reimbursement for therapeutic and diagnostic Injection services (CPT codes 96372-96379) whenreported with evaluation and management (E/M) services. R0009A.LA
Last Published 10.01.2023
Effective 10.01.2023 – This policy addresses inpatient and outpatient mental health services.
Last Published 10.01.2023
Effective 10.01.2023 – This policy addresses inpatient and outpatient mental health services.
Last Published 04.01.2024
This policy describes the reimbursement for inpatient readmissions of members to the same facility for the same or related condition on the same date of service, planned readmissions and leave of absence readmissions within 30 days. R5023
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses insulin delivery for diabetes management. Applicable Procedure Codes: A4211, A4226, A9274, E0784, E0787, E1399, S1034, S1035, S1036, S1037.
Last Published 02.01.2024
The Intensity Modulated Radiation Therapy (IMRT) Policy addresses when an IMRT simulation is performed with an IMRT plan, reimbursement of the simulation will be included in the reimbursement for the IMRT plan whether the simulation is reported on the same or different date of service unless these services are being performed in support of a separate and distinct non-IMRT radiation therapy for a different tumor.
Last Published 04.01.2024
The Intensity Modulated Radiation Therapy (IMRT) Policy addresses when an IMRT simulation is performed on the same tumor within 90 days prior to an IMRT plan, reimbursement of the simulation will be included in the reimbursement for the IMRT plan whether the simulation is reported on the same or different date of service. R0130 Flag: IMR
Last Published 06.02.2023
The Intensity Modulated Radiation Therapy (IMRT) Policy addresses when an IMRT simulation is performed on the same tumor within 90 days prior to an IMRT plan, reimbursement of the simulation will be included in the reimbursement for the IMRT plan whether the simulation is reported on the same or different date of service. In addition, the IMRT policy addresses certain radiation therapy services that may be performed 30 days prior to, on, or as part of the development of the IMRT plan. For the purpose of this policy, the Same Group Physician and/or Other Health Care Professional is defined as all physicians and/or other health care professionals of the same group reporting the same Federal Tax Identification number.
Last Published 06.02.2023
The Intensity Modulated Radiation Therapy (IMRT) Policy addresses when an IMRT simulation is performed on the same tumor within 90 days prior to an IMRT plan, reimbursement of the simulation will be included in the reimbursement for the IMRT plan whether the simulation is reported on the same or different date of service.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of intensity-modulated radiation therapy (IMRT). Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of intensity-modulated radiation therapy (IMRT). Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of intensity-modulated radiation therapy (IMRT). Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of intensity-modulated radiation therapy (IMRT). Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of intensity-modulated radiation therapy (IMRT). Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of intensity-modulated radiation therapy (IMRT). Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of intensity-modulated radiation therapy (IMRT). Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of intensity-modulated radiation therapy (IMRT). Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of intensity-modulated radiation therapy (IMRT). Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 05.01.2024
Effective Date: 12.01.2023 – This policy addresses intensive behavioral therapy for autism spectrum disorder.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses interspinous bony fusion devices and decompression systems. Applicable Procedure Codes: 22853, 22854, 22859, 22867, 22868, 22869, 22870, 22899, C1821.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses interspinous bony fusion devices and decompression systems. Applicable Procedure Codes: 22853, 22854, 22859, 22867, 22868, 22869, 22870, 22899, C1821.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses interspinous bony fusion devices and decompression systems. Applicable Procedure Codes: 22853, 22854, 22859, 22867, 22868, 22869, 22870, 22899, C1821.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses interspinous bony fusion devices and decompression systems. Applicable Procedure Codes: 22853, 22854, 22859, 22867, 22868, 22869, 22870, 22899, C1821.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses surgical treatment for spine pain.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses interspinous bony fusion devices and decompression systems. Applicable Procedure Codes: 22853, 22854, 22859, 22867, 22868, 22869, 22870, 22899, C1821.
Last Published 02.01.2024
Effective Date: 04.01.2024 – This policy addresses interspinous bony fusion devices and decompression systems. Applicable Procedure Codes: 22853, 22854, 22859, 22867, 22868, 22869, 22870, 22899, C1821.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses interspinous bony fusion devices and decompression systems. Applicable Procedure Codes: 22853, 22854, 22859, 22867, 22868, 22869, 22870, 22899, C1821.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses surgical treatment for spine pain. Applicable Procedure Codes: 22853, 22854, 22859, 22867, 22868, 22869, 22870, 22899, C1821.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses surgical treatment for spine pain. Applicable Procedure Codes: 22853, 22854, 22859, 22867, 22868, 22869, 22870, 22899, C1821.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses interspinous bony fusion devices and decompression systems. Applicable Procedure Codes: 22853, 22854, 22859, 22867, 22868, 22869, 22870, 22899, C1821.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of interspinous bony fusion devices and interspinous decompression systems. Applicable Procedure Codes: 22853, 22854, 22859, 22867, 22868, 22869, 22870, 22899, C1821.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses interspinous bony fusion devices and decompression systems. Applicable Procedure Codes: 22853, 22854, , 22859, 22867, 22868, 22869, 22870, 22899, C1821.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses interspinous bony fusion devices and decompression systems. Applicable Procedure Codes: 22853, 22854, 22859, 22867, 22868, 22869, 22870, 22899, C1821.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy provides information about the use of certain specialty pharmacy medications administered by the intracanalicular and intravitreal routes for certain ophthalmologic conditions. Applicable Procedure Codes: J1096, J7311, J7312, J7313, J7314.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of specialty pharmacy medications administered by the intravitreal route for certain ophthalmologic conditions. Applicable Procedure Codes: J1096, J7311, J7312, J7313, J7314.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of specialty pharmacy medications administered by the intravitreal route for certain ophthalmologic conditions. Applicable Procedure Codes: J1096, J7311, J7312, J7313, J7314.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of specialty pharmacy medications administered by the intracanalicular and intravitreal routes for certain ophthalmologic conditions. Applicable Procedure Codes: J1096, J7311, J7312, J7313, J7314.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of specialty pharmacy medications administered by the intracanalicular and intravitreal routes for certain ophthalmologic conditions. Applicable Procedure Codes: J1096, J7311, J7312, J7313, J7314.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). Applicable Procedure Code: 96549.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). Applicable Procedure Code: 96549.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). Applicable Procedure Code: 96549.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). Applicable Procedure Code: 96549.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). Applicable Procedure Code: 96549.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). Applicable Procedure Code: 96549.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). Applicable Procedure Code: 96549.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). Applicable Procedure Code: 96549.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC). Applicable Procedure Code: 96549.
Last Published 04.02.2024
This policy addresses the reimbursement of Intraoperative Neuromonitoring (IONM) services. R5008 Flag: INM
Last Published 01.03.2024
Per the American Medical Association, Intraoperative Neuromonitoring (IONM) is the use of electrophysiological methods to monitor the functional integrity of certain neural structures during surgery. The purpose of IONM is to reduce the risk of damage to the patient’s nervous system and to provide functional guidance to the surgeon and anesthesiologist. IONM codes are reported based upon the time spent monitoring only, and not the number of baseline tests performed or parameters monitored. In addition, time spent monitoring excludes time to set up, record, and interpret the baseline studies, and to remove electrodes at the end of the procedure. Time spent performing or interpreting the baseline neurophysiologic study(ies) should not be counted as intraoperative monitoring, as it represents separately reportable procedures. According to The Centers for Medicare and Medicaid Services (CMS), Intraoperative neurophysiology Reimbursement Policy CMS 1500 Policy Number 2021R5008A Proprietary information of UnitedHealthcare Community Plan. Copyright 2021 United HealthCare Services, Inc. 2021R5008A testing (HCPCS/CPT codes 95940 and G0453) should not be reported by the physician performing an operative or anesthesia procedure since it is included in the global package.
Last Published 02.01.2024
This policy addresses the reimbursement of Intraoperative Neuromonitoring (IONM) services. Per the American Medical Association, Intraoperative Neuromonitoring (IONM) is the use of electrophysiological methods to monitor the functional integrity of certain neural structures during surgery.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses intrauterine fetal surgery. Applicable Procedure Codes: 59072, 59074, 59076, 59897, S2400, S2401, S2402, S2403, S2404, S2405, S2409, S2411.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses intrauterine fetal surgery. Applicable Procedure Codes: 59074, 59076, 59897, S2400, S2401, S2402, S2403, S2404, S2405, S2409, S2411.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses intrauterine fetal surgery. Applicable Procedure Codes: 59072, 59074, 59076, 59897, S2400, S2401, S2402, S2403, S2404, S2405, S2409, S2411.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses intrauterine fetal surgery (IUFS) and fetoscopic endoluminal tracheal occlusion (FETO). Applicable Procedure Codes: 59072, 59074, 59076, 59897, S2400, S2401, S2402, S2403, S2404, S2405, S2409, S2411.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses intrauterine fetal surgery. Applicable Procedure Codes: 59072, 59074, 59076, 59897, S2400, S2401, S2402, S2403, S2404, S2405, S2409, S2411.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of intravenous enzyme replacement drug products for the treatment of Gaucher disease, including Cerezyme® (imiglucerase), Elelyso® (taliglucerase), and VPRIV® (velaglucerase). Applicable Procedure Codes: J1786, J3060, J3385.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of intravenous enzyme replacement drug products for the treatment of Gaucher disease, including Cerezyme® (imiglucerase), Elelyso® (taliglucerase), and VPRIV® (velaglucerase). Applicable Procedure Codes: J1786, J3060, J3385.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of intravenous enzyme replacement drug products for the treatment of Gaucher disease, including Cerezyme® (imiglucerase), Elelyso® (taliglucerase), and VPRIV® (velaglucerase). Applicable Procedure Codes: J1786, J3060, J3385
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of intravenous enzyme replacement drug products for the treatment of Gaucher disease, including Cerezyme® (imiglucerase), Elelyso® (taliglucerase), and VPRIV® (velaglucerase). Applicable Procedure Codes: J1786, J3060, J3385.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of intravenous enzyme replacement drug products for the treatment of Gaucher disease, including Cerezyme® (imiglucerase), Elelyso® (taliglucerase), and VPRIV® (velaglucerase). Applicable Procedure Codes: J1786, J3060, J3385.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of Feraheme® (ferumoxytol), Injectafer® (ferric carboxymaltose), and Monoferric® (ferric derisomaltose) for intravenous iron replacement therapy. Applicable Procedure Codes: J1437, J1439, Q0138, Q0139.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of intravenous iron replacement therapy with Feraheme® (ferumoxytol), Injectafer® (ferric carboxymaltose), and Monoferric® (ferric derisomaltose) for the treatment of iron deficiency anemia (IDA) with and without chronic kidney disease (CKD). Applicable Procedure Codes: J1437, J1439, Q0138, Q0139.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of intravenous iron replacement therapy with Feraheme® (ferumoxytol), Injectafer® (ferric carboxymaltose), and Monoferric® (ferric derisomaltose) for the treatment of iron deficiency anemia (IDA) with and without chronic kidney disease (CKD). Applicable Procedure Codes: J1437, J1439, Q0138, Q0139.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of intravenous iron replacement therapy with Feraheme® (ferumoxytol), Injectafer® (ferric carboxymaltose), and Monoferric® (ferric derisomaltose) for the treatment of iron deficiency anemia (IDA) with and without chronic kidney disease (CKD). Applicable Procedure Codes: J1437, J1439, Q0138, Q0139.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of intravenous iron replacement therapy with Feraheme® (ferumoxytol), Injectafer® (ferric carboxymaltose), and Monoferric® (ferric derisomaltose) for the treatment of iron deficiency anemia (IDA) with and without chronic kidney disease (CKD). Applicable Procedure Codes: J1437, J1439, Q0138, Q0139.
Last Published 06.01.2024
This policy addresses intravitreal corticosteroid implants, including Iluvien® (fluocinolone acetonide intravitreal implant). Applicable Procedure Code: J7313.
Last Published 06.01.2024
This policy addresses the use of Jevtana® (cabazitaxel) for the treatment for hormone-refractory metastatic prostate cancer. Applicable Procedure Code: J9043.
Last Published 06.01.2024
This policy addresses core decompression for avascular necrosis, hip resurfacing arthroplasty (HRA), hip/knee/elbow/shoulder replacement surgery (arthroplasty), endoscopic cubital tunnel release, elbow, and radiofrequency ablation of shoulder, hip or knee. Applicable Procedure Codes: 21299, 23470, 23472, 23929, 24360, 24361, 24362, 24363, 24365, 25441, 25442, 25444, 25446, 25449, 27120, 27122, 27125, 27130, 27132, 27134, 27137, 27138, 27299, 27412, 27415, 27416, 27445, 27446, 27447, 27486, 27487, 27599, 27700, 27899, 29834, 29837, 29840, 29844, 29845, 29846, 29847, 29860, 29861, 29862, 29863, 29866, 29867, 29868, 29891, 29892, 29894, 29895, 29897, 29898, 29899, 29914, 29915, 29916, 29999, 64718, J7330.
Last Published 11.15.2023
This policy identifies circumstances in which UnitedHealthcare Community Plan will reimburse physicians or other health care professionals for OB (Obstetrical) Sonograms for Kansas Medicaid.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Ketalar® (ketamine) for anesthesia purposes and Spravato® (esketamine) for the treatment of treatment-resistant depression (TRD) and major depressive disorder (MDD). Applicable Procedure Codes: J3490, S0013.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Ketalar® (ketamine) for anesthesia purposes and Spravato® (esketamine) for the treatment of treatment-resistant depression (TRD) and major depressive disorder (MDD). Applicable Procedure Codes: J3490, S0013.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Ketalar® (ketamine) for anesthesia purposes and Spravato® (esketamine) for the treatment of treatment-resistant depression (TRD) and major depressive disorder (MDD). Applicable Procedure Codes: J3490, S0013.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Ketalar® (ketamine) for anesthesia purposes and Spravato® (esketamine) for the treatment of treatment-resistant depression (TRD) and major depressive disorder (MDD). Applicable Procedure Codes: J3490, S0013.
Last Published 04.19.2024
These guidelines provide evidence-based recommendations to aid clinicians in the treatment of particular diseases or groups of patients for all stages of chronic kidney disease (CKD) and related complications.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Korsuva® (difelikefalin) for the treatment of moderate-to-severe pruritus associated with chronic kidney disease in adults undergoing hemodialysis. Applicable Procedure Code: J0879.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Krystexxa® (pegloticase) for treatment of chronic gout refractory to conventional therapy. Applicable Procedure Code: J2507.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of Krystexxa® (pegloticase) for treatment of chronic gout refractory to conventional therapy. Applicable Procedure Code: J2507.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Krystexxa® (pegloticase) for treatment of chronic gout refractory to conventional therapy. Applicable Procedure Code: J2507.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Krystexxa® (pegloticase) for treatment of chronic gout refractory to conventional therapy. Applicable Procedure Code: J2507.
Last Published 02.01.2024
Effective Date: 10.01.2023 – This policy addresses labial veneers. Applicable Procedure Codes: D2960, D2961, D2962.
Last Published 06.01.2024
This policy describes the reimbursement methodology for laboratory panels and individual Component Codes, as well as reimbursement for venipuncture services, laboratory services performed in a facility setting, and laboratory handling. The policy also addresses place of service and date of service relating to laboratory services.
Last Published 11.14.2022
This policy describes the reimbursement methodology for laboratory panels and individual Component Codes, as well asreimbursement for venipuncture services, laboratory services performed in a facility setting, laboratory handling, surgicalpathology and clinical pathology consultations.
Last Published 11.28.2022
This protocol applies to members with MD-Individual Practice Association, Inc. (M.D. IPA), M.D. IPA Preferred, Optimum Choice®, Inc. (OCI) and Optimum Choice Preferred health plans and all network physicians and health care professionals. If you have questions, please contact UnitedHealthcare Provider Services.
Last Published 06.01.2024
This policy addresses laboratory tests and services (inpatient or outpatient). Applicable Procedure Code: 82306.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses closure (occlusion) of the left atrial appendage (LAA). Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses closure (occlusion) of the left atrial appendage (LAA). Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses closure (occlusion) of the left atrial appendage (LAA). Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses closure (occlusion) of the left atrial appendage (LAA). Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses closure (occlusion) of the left atrial appendage (LAA). Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses left atrial appendage closure (occlusion). Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses closure (occlusion) of the left atrial appendage (LAA). Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses closure (occlusion) of the left atrial appendage (LAA). Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses closure (occlusion) of the left atrial appendage (LAA). Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses closure (occlusion) of the left atrial appendage (LAA). Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses closure (occlusion) of the left atrial appendage (LAA). Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses closure (occlusion) of the left atrial appendage (LAA). Applicable Procedure Codes: 33267, 33268, 33269, 33340, 33999.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Lemtrada® (alemtuzumab) for treatment of relapsing forms of multiple sclerosis. Applicable Procedure Code: J0202.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Lemtrada® (alemtuzumab) for treatment of relapsing forms of multiple sclerosis. Applicable Procedure Code: J0202.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Lemtrada® (alemtuzumab) for treatment of relapsing forms of multiple sclerosis. Applicable Procedure Code: J0202.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Leqembi® (lecanemab-irmb) for the treatment of Alzheimer’s disease (AD). Applicable Procedure Code: J0174.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Leqembi® (lecanemab-irmb) for the treatment of Alzheimer’s disease (AD). Applicable Procedure Code: J0174.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Leqvio® (inclisiran) for the treatment of heterozygous familial hypercholesterolemia (HeFH) and clinical atherosclerotic cardiovascular disease (ASCVD). Applicable Procedure Code: J1306.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Leqvio® (inclisiran) for the treatment of heterozygous familial hypercholesterolemia (HeFH) and clinical atherosclerotic cardiovascular disease (ASCVD). Applicable Procedure Code: J1306.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses the use of Leqvio® (inclisiran) for the treatment of primary hyperlipidemia, heterozygous familial hypercholesterolemia (HeFH), and clinical atherosclerotic cardiovascular disease (ASCVD). Applicable Procedure Code: J1306.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Leqvio® (inclisiran) for the treatment of heterozygous familial hypercholesterolemia (HeFH) and clinical atherosclerotic cardiovascular disease (ASCVD). Applicable Procedure Codes: C9399, J3490, J3590.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Applicable Procedure Codes: 17106, 17107, 17108, 17380.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Applicable Procedure Codes: 0479T, 0480T, 17106, 17107, 17108, 17380, 17999.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Applicable Procedure Codes: 0479T, 0480T, 17106, 17107, 17108, 17380, 17999.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Applicable Procedure Codes: 0479T, 0480T, 17106, 17107, 17108, 17380, 17999.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Applicable Procedure Codes: 17106, 17107, 17108, 17380.
Last Published 02.01.2024
Effective Date: 04.01.2024 – This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Applicable Procedure Codes: 17106, 17107, 17108, 17380.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Applicable Procedure Codes: 0479T, 0480T, 17106, 17107, 17108, 17380, 17999.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Applicable Procedure Codes: 0479T, 0480T, 17106, 17107, 17108, 17380, 17999.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Applicable Procedure Codes: 0479T, 0480T, 17106, 17107, 17108, 17380, 17999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Applicable Procedure Codes: 17106, 17107, 17108, 17380.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Applicable Procedure Codes: 17106, 17107, 17108, 17380.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses light and laser therapy, including light phototherapy, photodynamic therapy, intense pulsed light, pulsed dye laser, and laser hair removal. Applicable Procedure Codes: 0479T, 0480T, 17106, 17107, 17108, 17380, 17999.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses liposuction for lipedema when used to treat functional impairment. Applicable Procedure Codes: 15877, 15878, 15879.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses liposuction for lipedema when used to treat functional impairment. Applicable Procedure Codes: 15877, 15878, 15879.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses liposuction for lipedema when used to treat functional impairment. Applicable Procedure Codes: 15877, 15878, 15879.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses liposuction for lipedema when used to treat functional impairment. Applicable Procedure Codes: 15877, 15878, 15879.
Last Published 05.01.2023
Effective Date: 06.01.2023 – This policy addresses liposuction for lipedema when used to treat functional impairment. Applicable Procedure Codes: 15877, 15878, 15879.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses liposuction for lipedema when used to treat functional impairment. Applicable Procedure Codes: 15877, 15878, 15879.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses liposuction for lipedema when used to treat functional impairment. Applicable Procedure Codes: 15877, 15878, 15879.
Last Published 03.01.2024
Effective Date: 02.01.2024 – This policy addresses liposuction for lipedema when used to treat functional impairment. Applicable Procedure Codes: 15877, 15878, 15879.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses liposuction for lipedema when used to treat functional impairment. Applicable Procedure Codes: 15877, 15878, 15879.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses liposuction for lipedema when used to treat functional impairment. Applicable Procedure Codes: 15877, 15878, 15879.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses extracorporeal shock wave lithotripsy (ESWL) and endoscopic intracorporeal laser lithotripsy for treating salivary stones. Applicable Procedure Code: 42699.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses extracorporeal shock wave lithotripsy (ESWL) and endoscopic intracorporeal laser lithotripsy for treating salivary stones. Applicable Procedure Code: 42699.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses extracorporeal shock wave lithotripsy (ESWL) and endoscopic intracorporeal laser lithotripsy for treating salivary stones. Applicable Procedure Code: 42699.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses extracorporeal shock wave lithotripsy (ESWL) and endoscopic intracorporeal laser lithotripsy for treating salivary stones. Applicable Procedure Code: 42699.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses extracorporeal shock wave lithotripsy (ESWL) and endoscopic intracorporeal laser lithotripsy for treating salivary stones. Applicable Procedure Code: 42699.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses extracorporeal shock wave lithotripsy (ESWL) and endoscopic intracorporeal laser lithotripsy for treating salivary stones. Applicable Procedure Code: 42699.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses extracorporeal shock wave lithotripsy (ESWL) and endoscopic intracorporeal laser lithotripsy for treating salivary stones. Applicable Procedure Code: 42699.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses extracorporeal shock wave lithotripsy (ESWL) and endoscopic intracorporeal laser lithotripsy for treating salivary stones. Applicable Procedure Code: 42699.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses extracorporeal shock wave lithotripsy (ESWL) and endoscopic intracorporeal laser lithotripsy for treating salivary stones. Applicable Procedure Code: 42699.
Last Published 06.01.2024
This policy addresses long-term wearable electrocardiographic monitoring. Applicable Procedure Codes: 93224, 93225, 93226, 93227, 93228, 93229, 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248, 93268, 93270, 93271, 93272.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses lower extremity endovascular procedures. Applicable Procedure Codes: 0238T, 0505T, 37220, 37221, 37222, 37223, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses lower extremity vascular angiography and endovascular revascularization procedures. Applicable Procedure Codes: 0238T, 0505T, 37220, 37221, 37222, 37223, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses lower extremity endovascular procedures. Applicable Procedure Codes: 0238T, 0505T, 37220, 37221, 37222, 37223, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235.
Last Published 07.01.2023
Effective Date: 09.01.2023 – This policy addresses lower extremity vascular angiography and endovascular revascularization procedures. Applicable Procedure Codes: 37220, 37221, 37222, 37223, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses lower extremity vascular angiography and endovascular revascularization procedures. Applicable Procedure Codes: 0238T, 0505T, 37220, 37221, 37222, 37223, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses lower extremity endovascular procedures. Applicable Procedure Codes: 0238T, 0505T, 37220, 37221, 37222, 37223, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses endovascular revascularization procedures. Applicable Procedure Codes: 0238T, 0505T, 37220, 37221, 37222, 37223, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses lower extremity vascular angiography and endovascular revascularization procedures. Applicable Procedure Codes: 0238T, 0505T, 37220, 37221, 37222, 37223, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses lower extremity vascular angiography and endovascular revascularization procedures. Applicable Procedure Codes: 0238T, 0505T, 37220, 37221, 37222, 37223, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses lower extremity prosthetics.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses lower extremity prosthetics.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses lower extremity prosthetics.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses lower extremity prosthetics.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses lower extremity prosthetics.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses lower extremity prosthetics.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses lower extremity prosthetics.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses the use of lower extremity prosthetic for amputations, endoskeletal knee-shin system with microprocessor control, and combined microprocessor-controlled ankle foot system with power assist.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses lower extremity prosthetics.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of Luxturna® (voretigene neparvovec-rzyl) for the treatment of inherited retinal dystrophies (IRD) caused by mutations in the retinal pigment epithelium-specific protein 65kDa (RPE65) gene. Applicable Procedure Code: J3398.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Luxturna® (voretigene neparvovec-rzyl) for the treatment of inherited retinal dystrophies (IRD) caused by mutations in the retinal pigment epithelium-specific protein 65kDa (RPE65) gene. Applicable Procedure Code: J3398.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Luxturna® (voretigene neparvovec-rzyl) for the treatment of inherited retinal dystrophies (IRD) caused by mutations in the retinal pigment epithelium-specific protein 65kDa (RPE65) gene. Applicable Procedure Code: J3398.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Luxturna™ (voretigene neparvovec-rzyl) for the treatment of inherited retinal dystrophies (IRD) caused by mutations in the retinal pigment epithelium-specific protein 65kDa (RPE65) gene. Applicable Procedure Code: J3398.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses implantable miniature telescope (IMT), conjunctival incision with posterior extrascleral placement of a pharmacologic agent, laser photocoagulation, and radiation therapy. Applicable Procedure Codes: 0308T, 0378T, 0379T, 67036, 67299, 92499.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses implantable miniature telescope (IMT), conjunctival incision with posterior extrascleral placement of a pharmacologic agent, epiretinal radiation therapy, and laser photocoagulation. Applicable Procedure Codes: 0308T, 67036, 67299, 92499.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses implantable miniature telescope (IMT), conjunctival incision with posterior extrascleral placement of a pharmacologic agent, epiretinal radiation therapy, and laser photocoagulation. Applicable Procedure Codes: 0308T, 0378T, 0379T, 67036, 67299, 92499.
Last Published 09.01.2023
Effective Date: 07.01.2023 – This policy addresses implantable miniature telescope (IMT), conjunctival incision with posterior extrascleral placement of a pharmacologic agent, epiretinal radiation therapy, and laser photocoagulation. Applicable Procedure Codes: 0308T, 67036, 67299, 92499.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses implantable miniature telescope (IMT), conjunctival incision with posterior extrascleral placement of a pharmacologic agent, epiretinal radiation therapy, and laser photocoagulation. Applicable Procedure Codes: 0308T, 67036, 67299, 92499.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses implantable miniature telescope (IMT), conjunctival incision with posterior extrascleral placement of a pharmacologic agent, epiretinal radiation therapy, and laser photocoagulation. Applicable Procedure Codes: 0308T, 0378T, 0379T, 67036, 67299, 92499.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses implantable miniature telescope (IMT), conjunctival incision with posterior extrascleral placement of a pharmacologic agent, epiretinal radiation therapy, and laser photocoagulation. Applicable Procedure Codes: 0308T, 0378T, 0379T, 67036, 67299, 92499.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses implantable miniature telescope (IMT), conjunctival incision with posterior extrascleral placement of a pharmacologic agent, epiretinal radiation therapy, and laser photocoagulation. Applicable Procedure Codes: 0308T, 0378T, 0379T, 67036, 67299, 92499.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses advanced radiologic imaging procedures performed in a hospital outpatient department.
Last Published 11.02.2023
Effective Date: 11.01.2023 – This policy addresses advanced radiologic imaging procedures performed in a hospital outpatient department.
Last Published 11.02.2023
Effective Date: 11.01.2023 – This policy addresses advanced radiologic imaging procedures performed in a hospital outpatient department.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses covered routine patient costs during qualified clinical trials. Applicable Procedure Codes: G0276, G0293, G0294, G2000, S9988, S9990, S9991, S9992, S9994, S9996.
Last Published 10.01.2023
Effective Date: 12.01.2023 – This policy addresses clinical trials. Applicable Procedure Codes: G0276, G0293, G0294, G2000, S9988, S9990, S9991, S9992, S9994, S9996.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses clinical trials. Applicable Procedure Codes: G0276, G0293, G0294, G2000, S9988, S9990, S9991, S9992, S9994, S9996.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses covered routine patient costs during qualified clinical trials. Applicable Procedure Codes: G0276, G0293, G0294, G2000, S9988, S9990, S9991, S9992, S9994, S9996.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses covered routine patient costs during qualified clinical trials. Applicable Procedure Codes: G0276, G0293, G0294, G2000, S9988, S9990, S9991, S9992, S9994, S9996.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses covered routine patient costs during qualified clinical trials. Applicable Procedure Codes: G0276, G0293, G0294, G2000, S9988, S9990, S9991, S9992, S9994, S9996.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses manipulation under anesthesia (MUA). Applicable Procedure Codes: 21073, 22505, 23700, 25259, 26340, 27198, 27275, 27570, 27860, D7830.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses manipulation under anesthesia (MUA). Applicable Procedure Codes: 21073, 22505, 23700, 25259, 26340, 27198, 27275, 27570, 27860, D7830.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses manipulation under anesthesia (MUA). Applicable Procedure Codes: 21073, 22505, 23700, 25259, 26340, 27198, 27275, 27570, 27860, D7830.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses manipulation under anesthesia (MUA). Applicable Procedure Codes: 21073, 22505, 23700, 25259, 26340, 27198, 27275, 27570, 27860, D7830.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses manipulation under anesthesia (MUA). Applicable Procedure Codes: 21073, 22505, 23700, 25259, 26340, 27198, 27275, 27570, 27860, D7830.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses manipulation under anesthesia (MUA). Applicable Procedure Codes: 21073, 22505, 23700, 25259, 26340, 27198, 27275, 27570, 27860, D7830.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses manipulation under anesthesia (MUA). Applicable Procedure Codes: 21073, 22505, 23700, 25259, 26340, 27198, 27275, 27570, 27860, D7830.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses manipulation under anesthesia (MUA). Applicable Procedure Codes: 21073, 22505, 23700, 25259, 26340, 27198, 27275, 27570, 27860, D7830.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses manipulation under anesthesia (MUA). Applicable Procedure Codes: 21073, 22505, 23700, 25259, 26340, 27198, 27275, 27570, 27860, D7830.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses manipulation under anesthesia (MUA). Applicable Procedure Codes: 21073, 22505, 25259, 27275, 27860, 23700, 24300, 26340, 27198, 27570, D7830.
Last Published 03.01.2024
Effective Date: 09.01.2023 – This policy addresses manipulative therapy. Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, S8990.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses manipulative therapy. Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, S8990.
Last Published 03.01.2024
Effective Date: 09.01.2023 – This policy addresses manipulative therapy. Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, S8990.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses manipulative therapy. Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, S8990.
Last Published 03.01.2024
Effective Date: 09.01.2023 – This policy addresses manipulative therapy. Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, S8990.
Last Published 03.01.2024
Effective Date: 09.01.2023 – This policy addresses manipulative therapy. Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, S8990.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses manipulative therapy. Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, S8990.
Last Published 07.01.2023
Effective Date: 09.01.2023 – This policy addresses manipulative therapy. Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, S8990.
Last Published 03.01.2024
Effective Date: 09.01.2023 – This policy addresses manipulative therapy. Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, S8990.
Last Published 03.01.2024
Effective Date: 09.01.2023 – This policy addresses manipulative therapy. Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943, S8990.
Last Published 05.01.2024
Effective 05.01.2024 – This policy addresses prenatal and postnatal care, inpatient maternity care, and newborn care.
Last Published 05.01.2024
Effective 05.01.2024 – This policy addresses prenatal and postnatal care, inpatient maternity care, and newborn care.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the maximum dosage per administration and dosing frequency for certain medications administered by a medical professional. Applicable Procedure Codes: C9151, J0129, J0222, J0225, J0517, J0638, J0717, J0897, J1071, J1300, J1301, J1303, J1304, J1306, J1449, J1602, J1745, J1747, J2182, J2327, J2350, J2356, J2357, J2506, J2507, J2786, J3032, J3121, J3145, J3245, J3262, J3357, J3358, J3380, J3489, J7170, J9022, J9023, J9035, J9119, J9173, J9228, J9271, J9299, J9311, J9312, J9332, J9333, J9334, J9355, Q5103, Q5104, Q5107, Q5108, Q5111, Q5112, Q5113, Q5114, Q5115, Q5116, Q5117, Q5118, Q5119, Q5120, Q5121, Q5122, Q5123, Q5126, Q5127, Q5129, Q5130, S0189.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the maximum dosage per administration and dosing frequency for certain medications administered by a medical professional.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the maximum dosage per administration and dosing frequency for certain medications administered by a medical professional.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the maximum dosage per administration and dosing frequency for certain medications administered by a medical professional.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the maximum dosage per administration and dosing frequency for certain medications administered by a medical professional.
Last Published 02.25.2024
The purpose of this policy is to ensure that UnitedHealthcare Community Plan reimburses physicians and other qualified health care professionals for the units billed without reimbursing for obvious billing submission, data entry errors or incorrect coding based on anatomic considerations, HCPCS/CPT code descriptors, CPT coding instructions, established UnitedHealthcare policies, nature of a service/procedure, nature of an analyte, nature of equipment, and unlikely clinical treatment. The term “units” refers to the number of times services with the same Current Procedural Terminology (CPT ®) or Healthcare Common Procedure Coding System (HCPCS) codes are provided per day by the same individual physician or other qualified health care professional. R0060
Last Published 12.29.2023
This guideline outlines the indications, minimum evaluation requirements, contraindications, and special considerations for the use of long-term, durable mechanical circulatory support devices.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of low-load prolonged-duration stretch devices, static progressive (SP) stretch splint devices, and patient actuated serial stretch (PASS) devices. Applicable Procedure Codes: E1399, E1800, E1801, E1806, E1810, E1811, E1812, E1815, E1816, E1818, E1830, E1831, E1841.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of low-load prolonged-duration stretch devices, static progressive (SP) stretch splint devices, and patient actuated serial stretch (PASS) devices. Applicable Procedure Codes: E1399, E1800, E1801, E1802, E1805, E1806, E1810, E1811, E1812, E1815, E1816, E1818, E1825, E1830, E1831, E1840, E1841.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of low-load prolonged-duration stretch devices, static progressive (SP) stretch splint devices, and patient actuated serial stretch (PASS) devices. Applicable Procedure Codes: E1399, E1800, E1801, E1802, E1805, E1806, E1810, E1811, E1812, E1815, E1816, E1818, E1825, E1830, E1831, E1840, E1841.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses the use of low-load prolonged-duration stretch devices, static progressive (SP) stretch splint devices, and patient actuated serial stretch (PASS) devices. Applicable Procedure Codes: E1399, E1800, E1801, E1802, E1805, E1806, E1810, E1811, E1812, E1815, E1816, E1818, E1825, E1830, E1831, E1840, E1841.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of low-load prolonged-duration stretch devices, static progressive (SP) stretch splint devices, and patient actuated serial stretch (PASS) devices. Applicable Procedure Codes: E1399, E1800, E1801, E1802, E1805, E1806, E1810, E1811, E1812, E1815, E1816, E1818, E1825, E1830, E1831, E1840, E1841.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses the use of low-load prolonged-duration stretch devices, static progressive (SP) stretch splint devices, and patient actuated serial stretch (PASS) devices. Applicable Procedure Codes: E1399, E1800, E1801, E1802, E1805, E1806, E1810, E1811, E1812, E1815, E1816, E1818, E1825, E1830, E1831, E1840, E1841.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses the use of low-load prolonged-duration stretch devices, static progressive (SP) stretch splint devices, and patient actuated serial stretch (PASS) devices. Applicable Procedure Codes: E1399, E1800, E1801, E1802, E1805, E1806, E1810, E1811, E1812, E1815, E1816, E1818, E1825, E1830, E1831, E1840, E1841.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses the use of low-load prolonged-duration stretch devices, static progressive (SP) stretch splint devices, and patient actuated serial stretch (PASS) devices. Applicable Procedure Codes: E1399, E1800, E1801, E1806, E1810, E1811, E1812, E1815, E1816, E1818, E1830, E1831, E1841.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses the use of low-load prolonged-duration stretch devices, static progressive (SP) stretch splint devices, and patient actuated serial stretch (PASS) devices. Applicable Procedure Codes: E1399, E1800, E1801, E1806, E1810, E1811, E1812, E1815, E1816, E1818, E1830, E1831, E1841.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses the use of low-load prolonged-duration stretch devices, static progressive (SP) stretch splint devices, and patient actuated serial stretch (PASS) devices. Applicable Procedure Codes: E1399, E1800, E1801, E1806, E1810, E1811, E1812, E1815, E1816, E1818, E1830, E1831, E1841.
Last Published 01.01.2024
Effective Date: 06.01.2023 – This policy addresses certain medical benefit medications that are healthcare provider administered and have been deemed therapeutically equivalent.
Last Published 11.27.2023
These Medical Condition Assessment Incentive Program Terms and Conditions For Out Of Network Providers¹ (“Terms and Conditions”) govern the Medical Condition Assessment Incentive Program (“MCAIP”).
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses medically necessary interventions.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses medically necessary interventions.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses drug products used as medical therapies for enzyme deficiency. Applicable Procedure Codes: C9399, J0180, J0217, J0218, J0219, J0221, J1203, J1322, J1458, J1743, J1931, J2508, J2840, J3397, J3490, J3590.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses drug products used as medical therapies for enzyme deficiency. Applicable Procedure Codes: C9399, J0180, J0217, J0219, J0221, J1322, J1458, J1743, J1931, J2508, J2840, J3397, J3490, J3590.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses drug products used as medical therapies for enzyme deficiency. Applicable Procedure Codes: J0180, J0219, J0221, J1322, J1458, J1743, J1931, J2840, J3397, J3490, J3590.
Last Published 02.01.2024
Effective Date: 11.01.2023 – This policy addresses medically necessary orthodontic treatment. Applicable Procedure Codes: D8010, D8020, D8030, D8040, D8070, D8080, D8090, D8220, D8660, D8670, D8680, D8695, D8696, D8697, D8698, D8699, D8701, D8702, D8703, D8704, D8999.
Last Published 02.26.2024
Medically Unlikely Edits (MUEs) define for many HCPCS / CPT codes the maximum allowable number of units of service by the same provider, for the same beneficiary, for the same date of service, on the same claim line. R7117
Last Published 12.29.2023
The Centers for Medicare and Medicaid Services (CMS) developed the Medically Unlikely Edits (MUE) program to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. The first edits were implemented January 1, 2007 and even today not all HCPCS/CPT codes have an MUE. Subsequent to implementation, there have been quarterly updates increasing the number of edits.
Last Published 11.27.2023
These Medicare Advantage Intermediate Physician Incentive Program For Out Of Network Providers Terms and Conditions (“Terms and Conditions”) govern the Medicare Advantage Intermediate Physician Incentive (“MA-IPi”) Program.
Last Published 11.27.2023
These Medicare Advantage Primary Care Physician Incentive Program For Out Of Network Providers Terms and Conditions (“Terms and Conditions”) govern the Medicare Advantage Primary Care Physician Incentive (“MA-PCPi”) Program.
Last Published 06.23.2023
A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. The National Physician Fee Schedule (NPFS) Relative Value File contains information on services covered under the Medicare Physician Fee Schedule (MPFS). For more than 10,000 physician services, the file contains the associated relative value units (RVUs), a fee schedule status indicator, and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.).
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses injectable drugs, off-label drug use, tobacco cessation medications, and outpatient drugs and prescription medications.
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses injectable drugs, off-label drug use, tobacco cessation programs/medications, human growth hormone, and outpatient drugs and prescription medications.
Last Published 01.01.2024
Effective 01.01.2024 – This policy addresses member-initiated second and third medical opinions.
Last Published 01.01.2024
Effective 01.01.2024 – This policy addresses member-initiated second and third medical opinions.
Last Published 10.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 09.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Coverage Summaries.
Last Published 10.01.2023
This bulletin provides complete details on recently approved, revised, and/or retired UnitedHealthcare Medicare Advantage Policy Guidelines.
Last Published 04.01.2024
Microsurgical Technique is the use of an operating microscope during a surgical procedure. Use of an operating microscope, reported with Current Procedural Terminology (CPT®) codes 64727 and 69990, is a reimbursable service in specified instances. For the purpose of this policy, the Same Individual Physician or Other Qualified Health Care Professional is the same individual rendering health care services reporting the same Federal Tax Identification number. R0038
Last Published 02.02.2024
Microsurgical Technique is the use of an operating microscope during a surgical procedure. Use of an operating microscope, reported with Current Procedural Terminology (CPT®) codes 64727 and 69990, is a reimbursable service in specified instances. For the purpose of this policy, the Same Individual Physician or Other Health Care Professional is the same individual rendering health care services reporting the same Federal Tax Identification number.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses minimally invasive procedures/devices for treating gastric and esophageal diseases. Applicable Procedure Codes: 43210, 43257, 43284, 43289, 43497, 43499, 43999.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses minimally invasive endoscopic procedures and devices for treating gastroesophageal reflux disease (GERD) and the Per Oral Endoscopic Myotomy (POEM) procedure for achalasia or diffuse esophageal spasm. Applicable Procedure Codes: 43210, 43257, 43284, 43289, 43497, 43499, 43999.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses minimally invasive procedures/devices for treating gastric and esophageal diseases. Applicable Procedure Codes: 43210, 43257, 43284, 43289, 43497, 43499, 43999.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses minimally invasive procedures for gastric and esophageal diseases. Applicable Procedure Codes: 43210, 43257, 43284, 43289, 43497, 43499, 43999.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses minimally invasive endoscopic procedures and devices for treating gastroesophageal reflux disease (GERD) and the Per Oral Endoscopic Myotomy (POEM) procedure for achalasia or diffuse esophageal spasm. Applicable Procedure Codes: 43210, 43257, 43284, 43289, 43497, 43499, 43999.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses minimally invasive endoscopic procedures and devices for treating gastroesophageal reflux disease (GERD) and the Per Oral Endoscopic Myotomy (POEM) procedure for achalasia or diffuse esophageal spasm. Applicable Procedure Codes: 43210, 43257, 43284, 43289, 43497, 43499, 43999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses minimally invasive endoscopic procedures and devices for treating gastroesophageal reflux disease (GERD) and the Per Oral Endoscopic Myotomy (POEM) procedure for achalasia or diffuse esophageal spasm. Applicable Procedure Codes: 43210, 43257, 43284, 43289, 43497, 43499, 43999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses minimally invasive endoscopic procedures and devices for treating gastroesophageal reflux disease (GERD) and the Per Oral Endoscopic Myotomy (POEM) procedure for achalasia or diffuse esophageal spasm. Applicable Procedure Codes: 43210, 43257, 43284, 43289, 43497, 43499, 43999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses minimally invasive endoscopic procedures and devices for treating gastroesophageal reflux disease (GERD) and the Per Oral Endoscopic Myotomy (POEM) procedure for achalasia or diffuse esophageal spasm. Applicable Procedure Codes: 43210, 43257, 43284, 43289, 43497, 43499, 43999.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses minimally invasive spine surgery procedures. Applicable Procedure Codes: 0200T, 0201T, 0275T, 22586, 22630, 22899, 62287, 62380, G0276.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses minimally invasive spine surgery procedures. Applicable Procedure Codes: 0200T, 0201T, 0275T, 22586, 22630, 22899, 62287, 62380, G0276.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses minimally invasive spine surgery procedures. Applicable Procedure Codes: 0200T, 0201T, 0275T, 22586, 22630, 22899, 62287, 62380, G0276.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses minimally invasive spine surgery procedures. Applicable Procedure Codes: 0200T, 0201T, 0275T, 22630, 22586, 22899, 62287, 62380, G0276.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses minimally invasive spine surgery procedures. Applicable Procedure Codes: 0200T, 0201T, 0275T, 22630, 22586, 22899, 62287, 62380, G0276.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses minimally invasive spine surgery procedures. Applicable Procedure Codes: 0200T, 0201T, 0275T, 22586, 22630, 22899, 62287, 62380, G0276.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses minimally invasive spine surgery procedures. Applicable Procedure Codes: 0200T, 0201T, 0275T, 22586, 22630, 22899, 62287, 62380, G0276.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses minimally invasive spine surgery procedures. Applicable Procedure Codes: 0200T, 0201T, 0275T, 22586, 22630, 22899, 62287, 62380, G0276.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses minimally invasive spine surgery procedures. Applicable Procedure Codes: 0200T, 0201T, 0275T, 22586, 22630, 22899, 62287, 62380, G0276.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses minimally invasive spine surgery procedures. Applicable Procedure Codes: 0200T, 0201T, 0274T, 0275T, 22586, 22630, 22899, 62287, 62380, G0276.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses minimally invasive spine surgery procedures. Applicable Procedure Codes: 0200T, 0201T, 0275T, 22586, 22630, 22899, 62287, 62380, G0276.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses minimally invasive spine surgery procedures. Applicable Procedure Codes: 0200T, 0201T, 0275T, 22630, 22586, 22899, 62287, 62380, G0276.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses minimally invasive spine surgery procedures. Applicable Procedure Codes: 0200T, 0201T, 0275T, 22630, 22586, 22899, 62287, 62380, G0276.
Last Published 02.01.2024
Effective Date: 12.01.2023 – This policy addresses in-office HbA1c and blood glucose level tests, caries susceptibility tests, brush biopsies, pulp vitality tests, adjunctive pre-diagnostic tests that aid in the detection of mucosal abnormalities including premalignant and malignant lesions (not to include cytology or biopsy procedures), and diagnostic casts. Applicable Procedure Codes: D0411, D0412, D0425, D0431, D0460, D0470, D0604, D0605, D0606, D7288.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses mobility devices, options, and accessories.
Last Published 07.01.2023
Effective Date: 09.01.2023 – This policy addresses manual wheelchairs, power mobility devices, wheelchair options and accessories, and seating systems.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses manual wheelchairs, power mobility devices, wheelchair options and accessories, and seating systems.
Last Published 06.01.2023
Effective Date: 06.01.2023 – This policy addresses mobility devices, options, and accessories.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses mobility devices, options, and accessories.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses mobility devices, options, and accessories.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses mobility devices, options, and accessories.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses mobility devices, options, and accessories.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses mobility devices, options, and accessories.
Last Published 04.14.2024
This reimbursement policy applies to services reported using the UB-04 claim form or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network outpatient facility claims. R5029
Last Published 02.25.2024
This reimbursement policy applies to services reported using the UB04 claim form or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network outpatient facility claims. F7023
Last Published 04.01.2024
Overview As defined in the Current Procedural Terminology (CPT) book, under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. Under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52 (reduced services), signifying that the service is reduced. This provides a means of reporting the reduced services without disturbing the identification of the basic service. It is not appropriate to use modifier 52 if a portion of the intended procedure was completed and a code exists which represents the completed portion of the intended procedure.
Last Published 04.01.2024
According to the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS), a modifier provides the means to report or indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code. 2023R0111
Last Published 05.29.2024
According to the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS), a modifier provides the means to report or indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code. R0111
Last Published 04.01.2024
This policy sets forth UnitedHealthcare’s policy regarding reimbursement for claims appended with modifier SU, Procedure performed in physician’s office (to denote use of facility and equipment), in an office place of service. R0120 Flag: MSUDN
Last Published 04.07.2023
This policy sets forth UnitedHealthcare Community Plan’s policy regarding reimbursement for claims appended with modifier SU, Procedure performed in physician’s office (to denote use of facility and equipment), in an office place of service.
Last Published 09.12.2023
In accordance with the CPT book and CMS, the following modifiers have been approved and designated for use by ambulatory surgery centers (ASC) or in the outpatient hospital setting.
Last Published 04.02.2024
This policy describes reimbursement guidelines for reporting Mohs Micrographic Surgery which includes both the excision and pathology services. All services described in this policy may be subject to additional UnitedHealthcare reimbursement policies including, but not limited to, the CCI Editing Policy and the Laboratory Services Policy. Flag: MOH
Last Published 07.31.2023
This policy describes reimbursement guidelines for reporting Mohs Micrographic Surgery which includes both the excision and pathology services. All services described in this policy may be subject to additional UnitedHealthcare Community Plan reimbursement policies including, but not limited to, the CCI Editing Policy and the Laboratory Services Policy.
Last Published 05.01.2024
This policy describes reimbursement guidelines for reporting Mohs Micrographic Surgery which includes both the excision and pathology services.
Last Published 06.01.2024
This policy addresses molecular diagnostic testing for infectious diseases, including deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) based analysis.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses companion diagnostic tests using comprehensive genomic profiling (CGP) for oncology indications. Applicable Procedure Codes: 0022U, 0037U, 0179U, 0239U, 0242U, 81445, 81449, 81450, 81451, 81455, 81456, 81479, 81599.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses companion diagnostic tests using comprehensive genomic profiling (CGP) for oncology indications. Applicable Procedure Codes: 0022U, 0037U, 0179U, 0239U, 0242U, 81445, 81449, 81450, 81451, 81455, 81456, 81479, 81599.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses companion diagnostic tests using comprehensive genomic profiling (CGP) for oncology indications. Applicable Procedure Codes: 0022U, 0037U, 0179U, 0239U, 0242U, 81445, 81449, 81450, 81451, 81455, 81456, 81479, 81599.
Last Published 06.01.2023
Effective Date: 06.01.2023 – This policy addresses molecular oncology testing for cancer indications, including breast cancer, thyroid cancer, hematological cancer, and lung cancer.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses molecular oncology testing for hematologic cancer. Applicable Procedure Codes: 0017M, 0050U, 0120U, 0171U, 0285U, 0296U, 0331U, 0364U, 81450, 81451, 81455, 81456, 81479, 81599.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses molecular oncology testing for hematologic cancer. Applicable Procedure Codes: 0017M, 0050U, 0120U, 0171U, 0285U, 0296U, 0331U, 0364U, 81450, 81451, 81455, 81456, 81479, 81599.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses molecular oncology testing for hematologic cancer. Applicable Procedure Codes: 0017M, 0050U, 0120U, 017U, 0285U, 0331U, 0364U, 81450, 81451, 81455, 81456, 81479, 81599.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses molecular oncology testing for hematologic cancer. Applicable Procedure Codes: 0017M, 0050U, 0120U, 0171U, 0285U, 0296U, 0331U, 0364U, 81450, 81451, 81455, 81456, 81479, 81599.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses molecular oncology testing for hematologic cancer. Applicable Procedure Codes: 0017M, 0050U, 0120U, 0171U, 0285U, 0296U, 0331U, 0364U, 81450, 81451, 81455, 81456, 81479, 81599.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses molecular oncology testing for hematologic cancer. Applicable Procedure Codes: 0017M, 0050U, 0120U, 0171U, 0285U, 0296U, 0331U, 0364U, 81450, 81451, 81455, 81456, 81479, 81599.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses molecular oncology testing for hematologic cancer. Applicable Procedure Codes: 0017M, 0050U, 0120U, 0171U, 0285U, 0296U, 0331U, 0364U, 81450, 81451, 81455, 81456, 81479, 81599.
Last Published 05.01.2024
Effective Date: 01.01.2024 – This policy addresses molecular oncology testing for hematologic cancer. Applicable Procedure Codes: 0017M, 0050U, 0120U, 0171U, 0285U, 0296U, 0331U, 0364U, 81450, 81451, 81455, 81456, 81479, 81599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses molecular oncology testing for hematologic cancer. Applicable Procedure Codes: 0017M, 0050U, 0120U, 0171U, 0285U, 0296U, 0331U, 0364U, 81450, 81451, 81455, 81456, 81479, 81599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses molecular oncology testing for hematologic cancer. Applicable Procedure Codes: 0017M, 0050U, 0120U, 0171U, 0285U, 0296U, 0331U, 0364U, 81450, 81451, 81455, 81456, 81479, 81599.
Last Published 04.21.2024
This policy describes the information required when claims are submitted for Molecular Pathology services utilizing Tier 1 and Tier 2 Molecular Pathology codes, Genomic Sequencing Procedures (GSP) and other Molecular Multianalyte Assay codes, Proprietary Laboratory Analysis (PLA) codes and unlisted code 81479.All services described in this policy may be subject to additional UnitedHealthcare reimbursement policies including, but not limited to, the Clinical Laboratory Improvement Amendments (CLIA) ID Requirement Policy, the Laboratory Services Policy, and the CCI Editing Policy.
Last Published 04.01.2024
This policy describes the information required when claims are submitted for Molecular Pathology services utilizing Tier 1 and Tier 2 Molecular Pathology codes, Genomic Sequencing Procedures (GSP) and other Molecular Multianalyte Assay codes, Proprietary Laboratory Analysis (PLA) codes and unlisted code 81479.
Last Published 04.14.2024
UnitedHealthcare requires providers to submit a DEX Z-Code® with every Molecular Pathology Code submitted for these services to be considered for reimbursement. R0111
Last Published 06.01.2024
This policy describes the information required when claims are submitted for molecular pathology testing for MedicareAdvantage members. R9049
Last Published 06.01.2024
This policy addresses molecular pathology and genetic testing when reported with unlisted codes. Applicable Procedure Codes: 81479, 81599, 84999.
Last Published 06.01.2024
This policy addresses genetic testing and counseling, including tumor markers, cytogenetic studies, and molecular diagnostic genetic tests.
Last Published 06.01.2024
This policy addresses molecular and genetic tests that have proven efficacy in the diagnosis or treatment of medical conditions.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of monoclonal antibodies directed against amyloid, including Aduhelm® (aducanumab-avwa) and Leqembi™ (lecanemab-irmb), for the treatment of Alzheimer’s disease. Applicable Procedure Codes: J0172, J0174.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of monoclonal antibodies directed against amyloid, including Aduhelm® (aducanumab-avwa) and Leqembi™ (lecanemab-irmb), for the treatment of Alzheimer’s disease. Applicable Procedure Codes: J0172, J0174.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses motorized spinal traction devices. Applicable Procedure Code: S9090.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses motorized spinal traction devices. Applicable Procedure Code: S9090.
Last Published 04.01.2024
The UnitedHealthcare Policy is based on the Centers for Medicare and Medicaid Services (CMS) Multiple Procedure Payment Reduction (MPPR) Policy. UnitedHealthcare has adopted CMS guidelines that when multiple Diagnostic Cardiovascular Procedures or Diagnostic Ophthalmology Procedures are performed on the same day, most of the clinical labor activities are not performed or furnished twice. Flag: (Opthalm), MCR (Cardio)
Last Published 12.30.2023
The UnitedHealthcare Community Plan policy is based on the Centers for Medicare and Medicaid Services (CMS) Multiple Procedure Payment Reduction (MPPR) Policy. UnitedHealthcare Community Plan has adopted CMS guidelines that when multiple Diagnostic Cardiovascular Procedures or Diagnostic Ophthalmology Procedures are performed on the same day, most of the clinical labor activities are not performed or furnished twice. Specifically, UnitedHealthcare Community Plan considers that the following clinical labor activities, among others, are not duplicated for subsequent procedures: Greeting the patient. Positioning and escorting the patient. Providing education and obtaining consent. Retrieving prior exams. Setting up the IV. Preparing and cleaning the room.
Last Published 01.01.2023
This policy addresses the reimbursement of Multiple Procedure Payment Reduction (MPPR) on Diagnostic Cardiovascular and Ophthalmology Procedures.
Last Published 04.01.2024
The UnitedHealthcare policy is based on the Centers for Medicare and Medicaid Services (CMS) Multiple Procedure Payment Reduction (MPPR) Policy for those diagnostic imaging procedures where CMS assigns a Multiple Procedure Indicator (MPI) of 4 on the National Physician Fee Schedule (NPFS). R0085A Flag: MIR
Last Published 01.01.2024
Multiple Procedure Payment Reduction (MPPR) for Diagnostic Imaging Policy, Professional policy is based on the Centers for Medicare and Medicaid Services (CMS) MPPR Policy for those diagnostic imaging procedures where CMS assigns a Multiple Procedure Indicator (MPI) of 4 on the National Physician Fee Schedule (NPFS). Under the CMS guidelines, when multiple diagnostic imaging procedures are performed in a single session, most of the clinical labor activities and most supplies, with the exception of film, are not performed or furnished twice.
Last Published 05.01.2024
The UnitedHealthcare Medicare Advantage policy is based on the Centers for Medicare and Medicaid Services (CMS) Multiple Procedure Payment Reduction (MPPR) Policy for those diagnostic imaging procedures where CMS assigns a Multiple Procedure Indicator (MPI) of 4 on the CMS National Physician Fee Schedule (NPFS). UnitedHealthcare Medicare Advantage has adopted CMS guidelines that when multiple diagnostic imaging procedures are performed in a single session, most of the clinical labor activities and most supplies, with the exception of film, are not performed or furnished twice. Equipment time and indirect costs are allocated based on clinical labor time; therefore, these inputs should be reduced accordingly.
Last Published 02.02.2024
Many medical and surgical services include pre-procedure and post-procedure work, as well as generic services integral to the standard medical/surgical service. When multiple procedures are performed on the same day, by the Same Group Physician and/or Other Qualified Health Care Professional, reduction in reimbursement for secondary and subsequent procedures will occur. Payment at 100% for secondary and subsequent procedures would represent reimbursement for duplicative components of the primary procedure.
Last Published 04.01.2024
Many medical and surgical services include pre-procedure and post-procedure work, as well as generic services integral to the standard medical/surgical service. Flag: MPR, END and EMC. R0034
Last Published 04.01.2024
Multiple surgeries are separate procedures performed by a single physician on the same patient at the same operative session or on the same day for which separate payment may be allowed. Co-surgeons, surgical teams, or assistants at surgery may participate in performing multiple surgeries on the same patient on the same day. R9021
Last Published 03.01.2024
Section 3134 of The Affordable Care Act added section 1848(c)(2)(K) of The Social Security Act, which specifies that the Secretary of Health and Human Services shall identify potentially misvalued codes by examining multiple codes that are frequently billed in conjunction with furnishing a single service.
Last Published 02.25.2024
This policy describes the National Drug Code information that is required on professional drug claims and hospital outpatient facility claims that are reported for reimbursement. R6002A.LA
Last Published 05.26.2024
This policy describes the National Drug Code information that is required on professional and outpatient facility drug claims that are reported for reimbursement. R6002 Flag: NDC
Last Published 05.30.2024
This policy describes the National Drug Code information that is required on professional drug claims and hospital outpatient facility claims that are reported for reimbursement. National Drug Code (NDC) numbers are the industry standard identifier for drugs and provide full transparency to the medication administered. The NDC number identifies the manufacturer, drug name, dosage, strength, package size and quantity.
Last Published 05.31.2024
This policy describes the National Drug Code information that is required on professional and facility drug claims that are reported for reimbursement.National Drug Code (NDC) numbers are the industry standard identifier for drugs and provide full transparency to the medication administered. The NDC number identifies the manufacturer, drug name, dosage, strength, package size and quantity. R6002
Last Published 02.05.2024
Effective Date: 01.01.2024 – This policy addresses dental claim utilization review criteria, including a list of CDT codes and their applicable documentation requirements and/or related UnitedHealthcare Dental Clinical Policies and Coverage Guidelines detailing coverage criteria for Medicare Advantage plans.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses dental claim utilization review criteria, including a list of CDT codes and their applicable documentation requirements and/or related UnitedHealthcare Dental Clinical Policies and Coverage Guidelines detailing coverage criteria.
Last Published 06.02.2023
This policy describes how Nebraska facilities will be reimbursed for emergent and non-emergent services to UnitedHealthcare Community Plan members who seek services at the Emergency Room.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses negative pressure wound therapy. Applicable Procedure Codes: 97605, 97606, 97607, 97608, A6550, A9272, E2402.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses negative pressure wound therapy. Applicable Procedure Codes: 97605, 97606, 97607, 97608, A6550, A9272, E2402.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses negative pressure wound therapy. Applicable Procedure Codes: 97605, 97606, 97607, 97608, A6550, A9272, E2402.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses negative pressure wound therapy. Applicable Procedure Codes: 97605, 97606, 97607, 97608, A6550, A9272, E2402.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses negative pressure wound therapy. Applicable Procedure Codes: 97605, 97606, 97607, 97608, A6550, A9272, E2402.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses negative pressure wound therapy. Applicable Procedure Codes: 97605, 97606, 97607, 97608, A6550, A9272, E2402.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses negative pressure wound therapy. Applicable Procedure Codes: 97605, 97606, 97607, 97608, A6550, A9272, E2402.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses negative pressure wound therapy. Applicable Procedure Codes: 97605, 97606, 97607, 97608, A6550, A9272, E2402.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses negative pressure wound therapy. Applicable Procedure Codes: 97605, 97606, 97607, 97608, A6550, A9272, E2402.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses negative pressure wound therapy. Applicable Procedure Codes: 97605, 97606, 97607, 97608, A6550, A9272, E2402.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of Vyvgart®, Vyvgart® Hytrulo, & Rystiggo® for the treatment of myasthenia gravis. Applicable Procedure Codes: J9332, J9333, J9334.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of Vyvgart®, Vyvgart® Hytrulo, & Rystiggo® for the treatment of myasthenia gravis. Applicable Procedure Codes: J9332, J3490, J3590.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Vyvgart®, Vyvgart® Hytrulo, & Rystiggo® for the treatment of myasthenia gravis. Applicable Procedure Codes: C9399, J3490, J3590, J9332.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of Vyvgart®, Vyvgart® Hytrulo, & Rystiggo® for the treatment of myasthenia gravis. Applicable Procedure Codes: J9332, J9333, J9334.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses autologous (sural) and allogenic nerve grafts to restore erectile function during or after radical prostatectomy. Applicable Procedure Codes: 55899, 64999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses autologous (sural) and allogenic nerve grafts to restore erectile function during or after radical prostatectomy. Applicable Procedure Codes: 55899, 64999.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses sural or other nerve grafts to restore erectile function during radical prostatectomy. Applicable Procedure Codes: 55899, 64999.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses autologous (sural) and allogenic nerve grafts to restore erectile function during or after radical prostatectomy. Applicable Procedure Codes: 55899, 64999.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses autologous (sural) and allogenic nerve grafts to restore erectile function during or after radical prostatectomy. Applicable Procedure Codes: 55899, 64999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses autologous (sural) and allogenic nerve grafts to restore erectile function during or after radical prostatectomy. Applicable Procedure Codes: 55899, 64999.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses autologous (sural) and allogenic nerve grafts to restore erectile function during or after radical prostatectomy. Applicable Procedure Codes: 55899, 64999.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses autologous (sural) and allogenic nerve grafts to restore erectile function during or after radical prostatectomy . Applicable Procedure Codes: 55899, 64999.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses autologous (sural) and allogenic nerve grafts to restore erectile function during or after radical prostatectomy. Applicable Procedure Codes: 55899, 64999.
Last Published 06.01.2024
This policy addresses neurologic services and procedures, neurophysiological studies and neuropsychological testing, including but not limited to surgical procedures, cranial treatments, and seizure treatments.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses nerve conduction studies and other neurophysiological testing.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses nerve conduction studies and other neurophysiological testing.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses nerve conduction studies and other neurophysiological testing. Applicable Procedure Codes: 0106T, 0107T, 0108T, 0109T, 0110T, 0464T, 0778T, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870, 95872, 95873, 95874, 95885, 95886, 95887, 95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95937, 95999, 96002, 96003, 96004, A9279, A9280, G0255, S3900.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses nerve conduction studies and other neurophysiological testing. Applicable Procedure Codes: 0106T, 0107T, 0108T, 0109T, 0110T, 0464T, 0778T, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870, 95872, 95873, 95874, 95885, 95886, 95887, 95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95937, 95999, 96002, 96003, 96004, A9279, A9280, G0255, S3900.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses nerve conduction studies and other neurophysiological testing. Applicable Procedure Codes: 0106T, 0107T, 0108T, 0109T, 0110T, 0464T, 0778T, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870, 95872, 95873, 95874, 95885, 95886, 95887, 95905, 95907, 95908, 95909, 95910, 95911, 95912, 95913, 95937, 95999, 96002, 96003, 96004, A9279, A9280, G0255, S3900.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses nerve conduction studies and other neurophysiological testing.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses nerve conduction studies and other neurophysiological testing.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses nerve conduction studies and other neurophysiological testing.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses nerve conduction studies and other neurophysiological testing.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses nerve conduction studies and other neurophysiological testing.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses neuropsychological testing and computerized cognitive testing under the medical benefit. Applicable Procedure Codes: 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139, 96146.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses neuropsychological testing and computerized cognitive testing under the medical benefit. Applicable Procedure Codes: 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139, 96146.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses neuropsychological testing and computerized cognitive testing under the medical benefit. Applicable Procedure Codes: 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139, 96146.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses neuropsychological testing and computerized cognitive testing under the medical benefit. Applicable Procedure Codes: 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139, 96146.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses neuropsychological testing and computerized cognitive testing under the medical benefit. Applicable Procedure Codes: 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139, 96146.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses neuropsychological testing and computerized cognitive testing under the medical benefit. Applicable Procedure Codes: 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139, 96146.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses neuropsychological testing and computerized cognitive testing under the medical benefit. Applicable Procedure Codes: 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139, 96146.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses neuropsychological testing and computerized cognitive testing under the medical benefit. Applicable Procedure Codes: 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139, 96146.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses neuropsychological testing and computerized cognitive testing under the medical benefit. Applicable Procedure Codes: 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139, 96146.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses neuropsychological testing and computerized cognitive testing under the medical benefit. Applicable Procedure Codes: 96116, 96121, 96132, 96133, 96136, 96137, 96138, 96139, 96146.
Last Published 09.27.2022
On Nov. 1, 2022 for New Jersey Community Plan, we’ll add outpatient CPT® codes to prior authorization and site of service.
Last Published 10.01.2022
On Nov. 1, 2022, we’re adding 5 new sleep study CPT® codes for New Jersey Community Plan.
Last Published 08.28.2023
This policy describes reimbursement guidelines for the denial of non-medically indicated early elective deliveries (EEDs). New Jersey FamilyCare (NJFC) Medicaid will not reimburse for non-medically indicated EEDs.
Last Published 11.02.2022
This policy describes how New Jersey facilities will be reimbursed for emergent and non-emergent services to UnitedHealthcare Community Plan members who seek services at the Emergency Room.
Last Published 04.01.2024
This policy addresses the appropriate submission of a New Patient Evaluation and Management (E/M) service codes or Initial Visit HCPCS codes. R0004 Flag: NPT
Last Published 04.14.2024
This policy addresses the appropriate submission of a New Patient Evaluation and Management (E/M) service code and an Initial Visit HCPCS code. R0004
Last Published 06.01.2024
This policy addresses the appropriate submission of a New Patient Evaluation and Management (E/M) service code and an Initial Visit HCPCS code. R9024
Last Published 02.01.2024
This policy describes reimbursement for non-chemotherapy therapeutic and diagnostic injection services (CPT codes 96372-96379), infusion (CPT 96365-96371) and intravenous fluid infusion for hydration (CPT codes 96360-96361) when reported with evaluation and management (E/M) services.
Last Published 05.31.2024
UnitedHealthcare Community Plan considers any CPT and HCPCS codes that are not on a state Medicaid fee schedule as not covered for that state’s Medicaid market unless there are benefit &/or contractual agreements with negotiated rates. R7102
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses non-ionizing diagnostic procedures. Applicable Procedure Code: D0600.
Last Published 03.27.2019
For mastectomy surgeon using non-par reconstruction surgeon
Last Published 11.23.2022
This policy describes reimbursement for Evaluation and Management (E/M) services (99201–99499) reported by nonphysician health care professionals.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses direct and indirect pulp cap, therapeutic pulpotomy, partial pulpectomy for apexogenesis, apexification/recalcification, pulpal regeneration, pulpal debridement, pulpal and endodontic therapies, treatment of root canal obstruction, incomplete endodontic therapy for inoperable/ unrestorable/fractured tooth, internal root repair of perforation defects, and retreatment of previous root canal therapy. Applicable Procedure Codes: D3110, D3120, D3220, D3221, D3222, D3230, D3240, D3310, D3320, D3330, D3331, D3332, D3333, D3346, D3347, D3348, D3351, D3352, D3353, D3355, D3356, D3357, D3911, D3921.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses non-surgical extractions. Applicable Procedure Codes: D7111, D7140.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses scaling and root planning, localized delivery of antimicrobial agents, periodontal maintenance, scaling in presence of generalized moderate or severe gingival inflammation (full mouth), and gingival irrigation. Applicable Procedure Codes: D4341, D4342, D4346, D4381, D4910, D4921.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses warming therapy, noncontact normothermic wound therapy, and low frequency ultrasound for treating wounds. Applicable Procedure Codes: 0598T, 0599T, 97610, A6000, E0231, E0232.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses warming therapy, noncontact normothermic wound therapy, noncontact real-time fluorescence wound imaging, and low frequency ultrasound for treating wounds. Applicable Procedure Codes: 0598T, 0599T, 97610, A6000, E0231, E0232.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses warming therapy, noncontact normothermic wound therapy, and low frequency ultrasound for treating wounds. Applicable Procedure Codes: 0598T, 0599T, 97610, A6000, E0231, E0232.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses warming therapy, noncontact normothermic wound therapy, and low frequency ultrasound for treating wounds. Applicable Procedure Codes: 0598T, 0599T, 97610, A6000, E0231, E0232.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses warming therapy, noncontact normothermic wound therapy, and low frequency ultrasound for treating wounds. Applicable Procedure Codes: 0598T, 0599T, 97610, A6000, E0231, E0232.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses warming therapy, noncontact normothermic wound therapy, and low frequency ultrasound for treating wounds. Applicable Procedure Codes: 0598T, 0599T, 97610, A6000, E0231, E0232.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses warming therapy, noncontact normothermic wound therapy, and low frequency ultrasound for treating wounds. Applicable Procedure Codes: 0598T, 0599T, 97610, A6000, E0231, E0232.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses warming therapy, noncontact normothermic wound therapy, noncontact real-time fluorescence wound imaging, and low frequency ultrasound for treating wounds. Applicable Procedure Codes: 0598T, 0599T, 97610, A6000, E0231, E0232.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses warming therapy, noncontact normothermic wound therapy, and low frequency ultrasound for treating wounds. Applicable Procedure Codes: 0598T, 0599T, 97610, A6000, E0231, E0232.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses warming therapy, noncontact normothermic wound therapy, and low frequency ultrasound for treating wounds. Applicable Procedure Codes: 0598T, 0599T, 97610, A6000, E0231, E0232.
Last Published 01.01.2024
This policy describes the correct coding methodology and reimbursement for certain nonphysician health care professional services. Flag: NHCDN
Last Published 04.01.2024
This policy describes reimbursement for Evaluation and Management (E/M) services (99201–99499) reported by nonphysician health care professionals. R0112 Flag: NPHDN
Last Published 05.30.2024
This policy describes reimbursement for Evaluation and Management (E/M) services (CPT codes 99091, 99202–99499) reported by nonphysician health care professionals. R0112
Last Published 09.22.2023
This policy describes reimbursement for Evaluation and Management (E/M) services (99201–99499) reported by nonphysician health care professionals.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Nplate® (romiplostim) for the treatment of chronic immune thrombocytopenic purpura (ITP). Applicable Procedure Code: J2796.
Last Published 04.19.2024
These guidelines outline interventions and practices for maintaining a healthy weight in children, adolescents, and adults.
Last Published 12.08.2023
Initial Observation Care CPT® codes 99218-99220 and Subsequent Observation Care CPT codes 99224-99226 are used to report evaluation and management (E/M) services provided to new or established patients designated as "observation status" in a hospital.
Last Published 12.08.2023
Initial Observation Care CPT® codes 99218-99220 and Subsequent Observation Care CPT codes 99224-99226 are used to report evaluation and management (E/M) services provided to new or established patients designated as "observation status" in a hospital. Flag: ODPDN
Last Published 01.17.2024
Initial Observation Care CPT® codes 99218-99220 and Subsequent Observation Care CPT codes 99224-99226 are used to report evaluation and management (E/M) services provided to new or established patients designated as "observation status" in a hospital.
Last Published 02.01.2024
Initial Observation Care CPT® codes 99218-99220 and subsequent Observation Care CPT codes 99224-99226 are used to report evaluation and management (E/M) services provided to new or established patients designated as "observation status" in a hospital.
Last Published 02.28.2024
The physician supervising the care of the patient designated as "observation status" is the only physician who can report an initial Observation Care CPT code (99218-99220).
Last Published 02.26.2024
Observation stay is an alternative to an inpatient admission that allows reasonable and necessary time to evaluate and render medically necessary services to a member whose diagnosis and treatment are not expected to exceed 24 hours but may extend to 48 hours, but no longer than 48 hours without a prior authorization.
Last Published 04.19.2024
Maternity care includes antepartum care, delivery services, and postpartum care. This policy describes reimbursement for global obstetrical (OB) codes and itemization of maternity care services.
Last Published 02.05.2024
Maternity care includes antepartum care, delivery services, and postpartum care. This policy describes reimbursement for global obstetrical codes and itemization of maternity care services. Unless otherwise specified, for the purposes of this policy, Same Group Physician and/or Other Qualified Health Care Professional includes all physicians and/or other qualified health care professionals of the same group reporting the same federal tax identification number.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses obstetrical ultrasounds. Applicable Procedure Codes: 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76815, 76816, 76817, 76818, 76819, 76820, 76821, 76825, 76826, 76827, 76828.
Last Published 11.06.2023
UnitedHealthcare Community Plan considers ultrasounds not medically necessary if done solely to determine the fetal sex, or to provide parents with a view and photograph of the fetus. Detailed ultrasound fetal anatomic examination is not considered medically necessary for routine screening of normal pregnancy. R7112
Last Published 02.05.2024
UnitedHealthcare Community Plan considers ultrasounds not medically necessary if done solely to determine the fetal sex, or to provide parents with a view and photograph of the fetus.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of prenatal or obstetrical ultrasound during pregnancy. Applicable Procedure Codes: 76376, 76377, 76801, 76802, 76805, 76810, 76811, 76812, 76815, 76816, 76817.
Last Published 10.01.2023
Last Published 05.01.2024
Effective Date: 03.01.2024 – This policy addresses nonsurgical and surgical treatment of obstructive sleep apnea (OSA). Applicable Procedure Codes: 21142, 21199, 21206, 21685, 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288, 41512, 41530, 41599, 42140, 42145, 42299, 64570, 64582, 64583, 64584, 93150, 93151, 93513, EE0485, E0486, E0492, E0493, E0530, E1399, K1027, L8679, L8680, L8686, S2080, S2900.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses nonsurgical and surgical treatment of obstructive sleep apnea (OSA). Applicable Procedure Codes: 0424T, 0425T, 0426T, 0427T, 0428T, 0429T, 0430T, 0431T, 0432T, 0433T, 0434T, 0435T, 0436T, 21142, 21199, 21206, 21685, 41512, 41530, 41599, 42140, 42145, 42299, 64570, 64582, 64583, 64584, A7049, E0485, E0486, E1399, K1001, K1027, K1028, K1029, L8679, L8680, L8686, S2080, S2900.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses nonsurgical and surgical treatment of obstructive sleep apnea (OSA). Applicable Procedure Codes: 21142, 21199, 21206, 21685, 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288, 41512, 41530, 41599, 42145, 42299, 64553, 64568, 64569, 64570, 64582, 64583, 64584, 93150, 93151, 93152, 93153, A7049, E0485, E0486, E0492, E0493, E0530, E1399, K1027, L8679, L8680, L8686, S2080, S2900.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses nonsurgical and surgical treatment of obstructive sleep apnea (OSA). Applicable Procedure Codes: 21142, 21199, 21206, 21685, 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288, 41512, 41530, 41599, 42145, 42299, 64553, 64568, 64569, 64570, 64582, 64583, 64584, 93150, 93151, 93152,93153, A7049, E0485, E0486, E0492, E0493, E0530, E1399, K1027, L8679, L8680, L8686, S2080, S2900.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses nonsurgical and surgical treatment of obstructive sleep apnea (OSA). Applicable Procedure Codes: 21142, 21199, 21206, 21685, 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288, 41512, 41530, 41599, 42145, 42299, 64553, 64568, 64569, 64570, 64582, 64583, 64584, 93150, 93151, 93152, 93153, A7049, E0485, E0486, E0493, E0530, E1399, K1027, L8679, L8680, L8686, S2080, S2900.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses nonsurgical and surgical treatment of obstructive sleep apnea (OSA). Applicable Procedure Codes: 0431T, 21142, 21199, 21206, 21685, 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288, 41512, 41530, 41599, 42140, 42145, 42299, 64570, 64582, 64583, 64584, 93150, 93151, 93152, 93153, A7049, E0485, E0486, E0492, E0493, E0530, E1399, K1027, L8679, L8680, L8686, S2080, S2900.
Last Published 05.23.2024
Effective Date: 03.01.2024 – This policy addresses nonsurgical and surgical treatment of obstructive sleep apnea (OSA). Applicable Procedure Codes: 21142, 21199, 21206, 21685, 41512, 41530, 41599, 42145, 42299, 64553, 64568, 64569, 64570, 64582, 64583, 64584, A4557, E0485, E0486, E0470, E0471, E0619, E1399, L8679, L8680, L8686, S2080, S2900.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses nonsurgical and surgical treatment of obstructive sleep apnea (OSA).
Last Published 06.01.2024
Effective Date: 03.01.2024 – This policy addresses nonsurgical and surgical treatment of obstructive sleep apnea (OSA). Applicable Procedure Codes: 21142, 21199, 21206, 21685, 33276,33277, 33278, 33279, 33280, 33281, 33287, 33288, 41512, 41530, 41599, 42140, 42145, 42299, 64570, 64582, 64583, 64584, 93150, 93151, 93152, 93153, A7049, E0485, E0486, E0492, E0493, E0530, E1399, K1027, L8679, L8680, L8686, S2080, S2900.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy nonsurgical and surgical treatment of obstructive sleep apnea (OSA). Applicable Procedure Codes: 21142, 21199, 21206, 21685, 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288, 41512, 41530, 41599, 42140, 42145, 42299, 64570, 64582, 64583, 64584, 93150, 93151, 93152, 93513, A7049, E0485, E0486, E0492, E0493, E0530, E1399, K1027, L8679, L8680, L8686, S2080, S2900.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses nonsurgical and surgical treatment of obstructive sleep apnea (OSA). Applicable Procedure Codes: 21142, 21199, 21206, 21685, 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288, 41512, 41530, 41599, 42140, 42145, 42299, 64553, 64568, 64569, 64570, 64582, 64583, 64584, 93150, 93151, 93152, 93153, A7049, E0485, E0486, E0492, E0493, E0530, E1399, K1027, L8679, L8680, L8686, S2080, S2900.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses nonsurgical and surgical treatment of obstructive sleep apnea (OSA). Applicable Procedure Codes: 0424T, 0425T, 0426T, 0427T, 0428T, 0429T, 0430T, 0431T, 0432T, 0433T, 0434T, 0435T, 0436T, 21142, 21199, 21206, 21685, 41512, 41530, 41599, 42145, 42299, 64553, 64568, 64569, 64570, 64582, 64583, 64584, A7049, E0485, E0486, E1399, K1001, K1027, K1028, K1029, L8679, L8680, L8686, S2080, S2900.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses nonsurgical and surgical treatment of obstructive sleep apnea (OSA). Applicable Procedure Codes: 21199, 21142, 21206, 21685, 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288, 41512, 41530, 41599, 42140, 42145, 42140, 42299, 64570, 64582, 64583, 64584, 93150, 93151, 93152, 93153, E0485, E0486, E0492 , E0493 , E0530, E1399, K1027, L8679, L8680, L8686, S2080, S2900.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses occipital neuralgia and headache treatments, including occipital nerve blocks and occipital nerve ablation. Applicable Procedure Codes: 63185, 63190, 64405, 64553, 64555, 64568, 64570, 64575, 64590, 64596, 64597, 64598, 64633, 64634, 64722, 64744, 64771, 64999, A4540, K1023, L8679, L8680, L8685.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses occipital neuralgia and headache treatments, including occipital nerve blocks and occipital nerve ablation. Applicable Procedure Codes: 63185, 63190, 64405, 64553, 64555, 64568, 64570, 64575, 64590, 64596, 64597, 64598, 64633, 64634, 64722, 64744, 64771, 64999, A4540, K1023, L8679, L8680, L8685.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses occipital neuralgia and headache treatments, including occipital nerve blocks and occipital nerve ablation. Applicable Procedure Codes: 63185, 63190, 64405, 64553, 64555, 64568, 64570, 64575, 64590, 64596, 64597, 64598, 64633, 64634, 64722, 64744, 64771, 64999, A4540, K1023, L8679, L8680, L8685.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses occipital neuralgia and headache treatments, including occipital nerve blocks and occipital nerve ablation. Applicable Procedure Codes: 63185, 63190, 64405, 64553, 64555, 64568, 64570, 64575, 64590, 64596, 64597, 64598, 64633, 64634, 64722, 64744, 64771, 64999, A4540, K1023, L8679, L8680, L8685.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses occipital neuralgia and headache treatments, including occipital nerve blocks and occipital nerve ablation. Applicable Procedure Codes: 63185, 63190, 64405, 64553, 64555, 64568, 64570, 64575, 64590, 64596, 64597, 64598, 64633, 64634, 64722, 64744, 64771, 64999, A4540, K1023, L8679, L8680, L8685.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses occipital neuralgia and headache treatments, including occipital nerve blocks and occipital nerve ablation. Applicable Procedure Codes: 63185, 63190, 64405, 64553, 64555, 64568, 64570, 64575, 64590, 64596, 64597, 64598, 64633, 64634, 64722, 64744, 64771, 64999, A4540, K1023, L8679, L8680, L8685.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses occipital neuralgia and headache treatments, including injection of local anesthetics and/or steroids used as occipital nerve blocks, neurostimulation or electrical stimulation, occipital neurectomy, radiofrequency ablation (thermal or pulsed) or denervation, rhizotomy, and surgical nerve decompression. Applicable Procedure Codes: 63185, 63190, 64405, 64553, 64555, 64568, 64570, 64575, 64590, 64596, 64597, 64598, 64633, 64634, 64722, 64744, 64771, 64999, A4540, K1023, L8679, L8680, L8685.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses occipital neuralgia and headache treatments, including occipital nerve blocks and occipital nerve ablation. Applicable Procedure Codes: 63185, 63190, 64405, 64553, 64555, 64568, 64570, 64575, 64590, 64596, 64597, 64598, 64633, 64634, 64722, 64744, 64771, 64999, A4540, K1023, L8679, L8680, L8685.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses occipital neuralgia and headache treatments, including occipital nerve blocks and occipital nerve ablation. Applicable Procedure Codes: 63185, 63190, 64405, 64553, 64555, 64568, 64570, 64575, 64590, 64596, 64597, 64598, 64633, 64634, 64722, 64744, 64771, 64999, A4540, K1023, L8679, L8680, L8685.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses occipital neuralgia and headache treatments, including occipital nerve blocks and occipital nerve ablation. Applicable Procedure Codes: 63185, 63190, 64405, 64553, 64555, 64568, 64570, 64575, 64590, 64596, 64597, 64598, 64633, 64634, 64722, 64744, 64771, 64999, A4540, K1023, L8679, L8680, L8685.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses occlusal guards. Applicable Procedure Codes: D9942, D9943, D9944, D9945, D9946.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Ocrevus® (ocrelizumab) for the treatment of multiple sclerosis. Applicable Procedure Code: J2350.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Ocrevus® (ocrelizumab) for the treatment of multiple sclerosis. Applicable Procedure Code: J2350.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Ocrevus® (ocrelizumab) for the treatment of multiple sclerosis. Applicable Procedure Code: J2350.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses off-label and unproven indications of FDA-approved injectable specialty drugs.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses certain elective procedures that are typically performed in an office setting but may be performed in an ambulatory surgical center in certain circumstances. Applicable Procedure Codes: 11402, 11403, 11404, 11406, 11420, 11421, 11422, 11423, 11424, 11426, 11442, 19000, 20552, 20553, 27096, 31579, 57460, 62270, 62321, 64479, 64490, 64493, 64633, 64635.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses certain elective procedures that are typically performed in an office setting but may be performed in an ambulatory surgical center in certain circumstances. Applicable Procedure Codes: 11402, 11403, 11404, 11406, 11420, 11421, 11422, 11423, 11424, 11426, 11442, 19000, 20552, 20553, 27096, 31579, 57460, 62270, 62321, 64479, 64490, 64493, 64633, 64635.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses multiple services/procedures.
Last Published 02.15.2024
Effective Date: 04.01.2024 – This policy addresses multiple services/procedures.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses multiple services/procedures.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses multiple services/procedures.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses multiple services/procedures.
Last Published 06.01.2023
Effective Date: 06.01.2023 – This policy addresses multiple services/procedures.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses multiple services/procedures.
Last Published 06.01.2024
This policy addresses certain items/services that do not have Medicare coverage criteria.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses multiple services/procedures.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses multiple services/procedures.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Omvoh™ (mirikizumab-mrkz) injections for the treatment of ulcerative colitis. Applicable Procedure Codes: C9399, J3490, J3590.
Last Published 04.01.2024
The Once in a Lifetime Procedures Policy identifies procedures that because of the Current Procedural Terminology (CPT®) code description and/or human anatomy can be performed by a physician(s) or other qualified health care professional(s) only once in a patient’s lifetime. R0116
Last Published 02.25.2024
The Once in a Lifetime Procedures Policy identifies procedures that because of the Current Procedural Terminology (CPT®) code description and/or human anatomy can be performed by a physician(s) or other health care professional(s) only once in a patient’s lifetime. R0116
Last Published 03.01.2024
UnitedHealthcare Medicare Advantage will reimburse certain procedures only once during a patient’s lifetime. Once in a Lifetime Procedures are not limited to a single CPT code, but may be represented by Code Families, which are a group of CPT codes that describe the same or similar type of service. Under this policy, UnitedHealthcare Medicare Advantage provides reimbursement for only one procedure from a designated Code Family during a patient’s lifetime.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses parameters for coverage of injectable oncology medications. Applicable Procedure Codes: A9513, A9590, A9606, A9607, A9699, J0640, J0641, J0642, J1930, J1932, J9198, J9199, J9201, J9310, J9312, Q5115, Q5119.
Last Published 04.01.2023
Effective Date: 04.01.2023 – This policy addresses parameters for coverage of injectable oncology medications. Applicable Procedure Codes: A9513, A9590, A9606, A9607, A9699, J0640, J0641, J0642, J9035, J9198, J9199, J9201, J9310, J9311, J9312, J9355, J9356, Q5107, Q5112, Q5113, Q5114, Q5115, Q5116, Q5117, Q5118, Q5119, Q5123, Q5126, Q5129.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses parameters for coverage of injectable oncology medications. Applicable Procedure Codes: A9513, A9590, A9606, A9607,A9699, J0640, J0641, J0642, J0881, J0882, J0885, J0887, J0888, J0897, J1442, J1447, J1449, J1930, J1932, J1950, J1951, J1952, J1954, J2353, J2354, J2502, J2506, J2820, J3315, J3316, J9155, J9198, J9199, J9201, J9202, J9217, J9226, J9310, J9311, J9312, J9316, J9348, J9353, Q4081, Q5101, Q5105, Q5106, Q5108, Q5110, Q5111, Q5119, Q5120, Q5122, Q5123 Q5125, Q5127, Q5130.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses parameters for coverage of injectable oncology medications. Applicable Procedure Codes: A9513, A9607, A9590, A9606, A9699, J0640, J0641, J0642, J9035, J9198, J9199, J9201, J9294, J9296, J9297, J9304, J9305 J9310, J9311, J9312, J9314 J9355, J9356, Q5107, Q5112, Q5113, Q5114, Q5115, Q5116, Q5117, Q5118, Q5119, Q5123, Q5126, Q5129.
Last Published 04.04.2024
This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products, all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals. Flag: OMSDN
Last Published 03.11.2024
Certain Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) code descriptions support reimbursement only once during the Defined Treatment Period. Per CPT, these codes include treatment at one or more sessions that may occur at different patient encounters.
Last Published 11.23.2022
Certain Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System (HCPCS) code descriptions support reimbursement only once during the Defined Treatment Period. Per CPT, these codes include treatment at one or more sessions that may occur at different patient encounters.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Izervay™ (avacincaptad pegol) and Syfovre™ (pegcetacoplan injection) for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Applicable Procedure Codes: J2781, J2782.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Izervay™ (avacincaptad pegol) and Syfovre™ (pegcetacoplan injection) for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Applicable Procedure Codes: J2781, J2782.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Izervay™ (avacincaptad pegol) and Syfovre™ (pegcetacoplan injection) for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Applicable Procedure Codes: C9399, J2781, J3490, J3590.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses the use of Izervay™ (avacincaptad pegol) and Syfovre™ (pegcetacoplan injection) for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Applicable Procedure Codes: J2781, J2782.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Izervay™ (avacincaptad pegol) and Syfovre™ (pegcetacoplan injection) for the treatment of geographic atrophy (GA) secondary to age-related macular degeneration (AMD). Applicable Procedure Codes: J2781, J2782.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of vascular endothelial growth factor (VEGF) inhibitors. Applicable Procedure Codes: J0177, J0178, J0179, J2777, J2778, J2779, J9035, Q5124, Q5128.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of vascular endothelial growth factor (VEGF) inhibitors. Applicable Procedure Codes: C9161, J0178, J0179, J2777, J2778, J2779, J9035, Q5124, Q5128.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses the use of vascular endothelial growth factor (VEGF) inhibitors. Applicable Procedure Codes: J0177, J0178, J0179, J2777, J2778, J9035, Q5124, Q5128.
Last Published 02.01.2024
Effective Date: 10.01.2023 – This policy addresses alveoloplasty and vestibuloplasty. Applicable Procedure Codes: 40840, 40842, 40843, 40844, 40845, 40899, 41874, D7310, D7311, D7320, D7321, D7340, D7350.
Last Published 02.01.2024
Effective Date: 08.01.2023 – This policy addresses oroantral fistula closure, primary closure of a sinus perforation, tooth reimplantation and/or stabilization of accidentally evulsed or displaced tooth, surgical repositioning of teeth, sinus augmentation procedures, and salivary gland and duct procedures. Applicable Procedure Codes: 21210, 21215, 30580, 41899, 42699, D7260, D7261, D7270, D7272, D7290, D7295, D7951, D7952, D7979, D7980, D7981, D7982, D7983, D7999.
Last Published 02.01.2024
Effective Date: 10.01.2023 – This policy addresses frenulectomy, frenuloplasty, excision of hyperplastic tissue (per arch), excision of pericoronal gingiva, surgical reduction of fibrous tuberosity, transseptal fiberotomy/supra crestal fiberotomy (by report), removal of lateral exostosis (maxilla or mandible), removal of torus palatinus, and removal of torus mandibularis. Applicable Procedure Codes: 21031, 21032, 40806, 40819, 41010, 41115, 41520, 41821, 41822, 41828, D7291, D7471, D7472, D7473, D7961, D7962, D7963, D7970, D7971, D7972, D7999.
Last Published 02.01.2024
Effective Date: 09.01.2023 – This policy addresses surgical placement of a temporary anchorage device (not related to distraction osteogenesis or orthognathic surgery), surgical access of an unerupted tooth, placement of a device to facilitate eruption of an impacted tooth, corticotomy (not related to distraction osteogenesis or orthognathic surgery), and mobilization of an erupted or malpositioned tooth to aid eruption. Applicable Procedure Codes: 41899, D7280, D7282, D7283, D7292, D7293, D7294, D7296, D7297, D7298, D7299, D7300, D7997.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Orencia® (abatacept) injection for intravenous infusion for the treatment of polyarticular juvenile idiopathic arthritis, rheumatoid arthritis, psoriatic arthritis, chronic graft-versus-host disease, and immune checkpoint inhibitor-related toxicities. Applicable Procedure Code: J0129.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Orencia® (abatacept) injection for intravenous infusion for the treatment of polyarticular juvenile idiopathic arthritis, rheumatoid arthritis, psoriatic arthritis, chronic graft-versus-host disease, and immune checkpoint inhibitor-related toxicities. Applicable Procedure Code: J0129.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Orencia® (abatacept) injection for intravenous infusion for the treatment of polyarticular juvenile idiopathic arthritis, rheumatoid arthritis, psoriatic arthritis, chronic graft-versus-host disease, immune checkpoint inhibitor-related toxicities and the prophylaxis of acute graft-versus-host disease. Applicable Procedure Code: J0129.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses orthognathic (jaw) surgery.
Last Published 06.01.2023
Effective Date: 08.01.2023 – This policy addresses orthognathic (jaw) surgery.
Last Published 05.01.2024
Effective Date: 08.01.2023 – This policy addresses orthognathic (jaw) surgery.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses orthognathic (jaw) surgery.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses orthognathic (jaw) surgery.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses orthognathic (jaw) surgery.
Last Published 06.01.2024
This policy addresses collagen meniscus implant, extracorporeal shock wave therapy (ESWT), bone/soft tissue healing and fusion enhancement products, manipulation under anesthesia (MUA), unicondylar spacer devices, athletic pubalgia surgery, autologous chondrocyte transplantation (knee), osteochondral grafting (knee), and open osteochondral autograft (talus). Applicable Codes: 0054T, 0055T, 0101T, 0102T, 0232T, 20985, 21073, 22505, 23700, 25259, 26340, 27198, 27275, 27570, 27599, 27860, 28635, 28890, 29799, 49659, 49999, 97139, 97799, A9999, P9020.
Last Published 06.01.2024
This policy addresses osteopathic manipulative treatments (OMT). Applicable Procedure Codes: 98925, 98926, 98927, 98928, 98929.
Last Published 02.01.2024
Effective Date: 08.01.2023 – This policy addresses repair/recement/rebound of single tooth indirect restorations, reattachment of tooth fragment and coping. Applicable Procedure Codes: D2910, D2915, D2920, D2921, D2971, D2975, D2980, D2981, D2982, D2983 and D2999.
Last Published 04.12.2024
Otoacoustic emissions (OAEs) are low-intensity sounds emitted by functioning outer hair cells of the cochlea. OAEs are measured by presenting a series of very brief clicks to the ear through a probe that is inserted in the outer third of the ear canal. The probe contains a loudspeaker that generates the clicks and a microphone for measuring the resulting OAEs that are produced in the cochlea and are then reflected back through the middle ear into the outer ear canal. OAE testing requires no behavioral or interactive feedback by the individual being tested. 2023R7104A
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses neonatal hearing screening, auditory screening, and diagnostic testing using otoacoustic emissions (OAEs). Applicable Procedure Codes: 92558, 92587, 92588.
Last Published 04.14.2024
The policy describes how UnitedHealthcare reimburses UB-04 claims for outpatient blood and blood products when submitted for transfusion, freezing or thawing, irradiation and splitting of a unit of a blood or blood product. R6012 Flag: UOBPD4
Last Published 04.14.2024
According to the Centers for Medicare and Medicaid Services (CMS), medical and surgical procedures should be reported with the CPT/HCPCS codes that most comprehensively describe the services performed. Flag: UCCIMD and UCCIDN
Last Published 05.24.2024
The purpose of this policy is to reimburse units billed for outpatient hospital services without reimbursing for obvious billing submission and data entry errors or incorrect coding based on anatomic considerations, Healthcare Common Procedure Coding System II (HCPCS)/Current Procedural Terminology CPT® (CPT) code descriptors, CPT coding instructions, established UnitedHealthcare policies, nature of a service/procedure, nature of an analyte, nature of equipment, and unlikely clinical treatment. The term “units” refers to the number of times services with the same CPT or HCPCS codes are provided per day by the same outpatient hospital. UnitedHealthcare has established Maximum Frequency per Day (MFD) values, which are the highest number of units eligible for reimbursement of services on a single date of service. Reimbursement also may be subject to the application of other UnitedHealthcare Reimbursement policies and/or Provider contracts. This policy applies The purpose of this policy is to reimburse units billed for outpatient hospital services without reimbursing for obvious billing submission and data entry errors or incorrect coding based on anatomic considerations, Healthcare Common Procedure Coding System II (HCPCS)/Current Procedural Terminology CPT® (CPT) code descriptors, CPT coding instructions, established UnitedHealthcare policies, nature of a service/procedure, nature of an analyte, nature of equipment, and unlikely clinical treatment. The term “units” refers to the number of times services with the same CPT or HCPCS codes are provided per day by the same outpatient hospital. UnitedHealthcare has established Maximum Frequency per Day (MFD) values, which are the highest number of units eligible for reimbursement of services on a single date of service. Reimbursement also may be subject to the application of other UnitedHealthcare Reimbursement policies and/or Provider contracts. R5011
Last Published 04.12.2024
This policy describes how UnitedHealthcare reimburses UB04 claims for outpatient medical visits when submitted in addition to other procedure codes and when in circumstances when multiple medical visit codes are submitted. The policy also addresses when trauma activation occurs in addition to critical care services.
Last Published 04.14.2024
This policy describes the requirements for reporting outpatient physical therapy (PT), occupational therapy (OT), and speech-language pathology (ST). R5016 Flag: URTSDN, URTSCD
Last Published 02.15.2024
This policy describes the requirements for reporting outpatient physical therapy (PT), occupational therapy (OT), and speech-language pathology (ST). R5061
Last Published 03.01.2024
Effective Date: 11.01.2023 – This policy addresses the medical necessity of certain planned surgical procedures when performed in a hospital outpatient department.
Last Published 05.01.2024
Effective Date: 08.01.2023 – This policy addresses the medical necessity of certain planned surgical procedures when performed in a hospital outpatient department.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the medical necessity of certain planned surgical procedures when performed in a hospital outpatient department.
Last Published 06.01.2024
This CPT/HCPCS Code List applies to the Medical Policy titled Outpatient Surgical Procedures – Site of Service.
Last Published 04.24.2019
NonPar Provider Consent Protocol
Last Published 04.24.2019
NonPar Provider Consent Protocol
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses self-referral for outpatient imaging services.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Oxlumo® (lumasiran) for the treatment of primary hyperoxaluria type 1 (PH1). Applicable Procedures Code: J0224.
Last Published 11.01.2023
Effective 11.01.2023 – This policy addresses pain management for long term and sudden pain.
Last Published 11.01.2023
Effective 11.01.2023 – This policy addresses pain management for long term and acute pain.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses panniculectomy, abdominoplasty, lipectomy, repair of diastasis recti, and suction-assisted lipectomy. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses panniculectomy, abdominoplasty, lipectomy, repair of diastasis recti, and suction-assisted lipectomy. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses panniculectomy, abdominoplasty, lipectomy, repair of diastasis recti, and suction-assisted lipectomy. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses panniculectomy, abdominoplasty, lipectomy, repair of diastasis recti, and suction-assisted lipectomy. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses panniculectomy, abdominoplasty, lipectomy, repair of diastasis recti, and suction-assisted lipectomy. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses panniculectomy, abdominoplasty, lipectomy, repair of diastasis recti, and suction-assisted lipectomy. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses panniculectomy, abdominoplasty, lipectomy, repair of diastasis recti, and suction-assisted lipectomy. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879.
Last Published 07.01.2023
Effective Date: 08.01.2023 – This policy addresses panniculectomy, abdominoplasty, lipectomy, repair of diastasis recti, and suction-assisted lipectomy. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses panniculectomy, abdominoplasty, lipectomy, repair of diastasis recti, and suction-assisted lipectomy. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses panniculectomy, abdominoplasty, lipectomy, repair of diastasis recti, and suction-assisted lipectomy. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Parsabiv® (etelcalcetide) for the treatment of secondary hyperparathyroidism with chronic kidney disease. Applicable Procedure Code: J0606.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Parsabiv® (etelcalcetide) for the treatment of secondary hyperparathyroidism with chronic kidney disease. Applicable Procedure Code: J0606.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Parsabiv® (etelcalcetide) for the treatment of secondary hyperparathyroidism with chronic kidney disease. Applicable Procedure Code: J0606.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses the use of Parsabiv® (etelcalcetide) for the treatment of secondary hyperparathyroidism with chronic kidney disease. Applicable Procedure Code: J0606.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Parsabiv® (etelcalcetide) for the treatment of secondary hyperparathyroidism with chronic kidney disease. Applicable Procedure Code: J0606.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses a participating provider's use of a non-participating provider physician, facility, or other healthcare provider in a member’s care, and the Member Advanced Notice Form.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses patient lifts. Applicable Procedure Codes: E0621, E0630, E0635, E0636, E0639, E0640, E1035, E1036.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses patient lifts. Applicable Procedure Codes: E0621, E0630, E0635, E0636, E0639, E0640, E1035, E1036.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses patient lifts. Applicable Procedure Codes: E0621, E0630, E0635, E0636, E0639, E0640, E1035, E1036.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses patient lifts. Applicable Procedure Codes: E0621, E0630, E0635, E0636, E0639, E0640, E1035, E1036.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses patient lifts. Applicable Procedure Codes: E0621, E0630, E0635, E0636, E0639, E0640, E1035, E1036.
Last Published 06.01.2023
Effective Date: 08.01.2023 – This policy addresses patient lifts. Applicable Procedure Codes: E0621, E0630, E1035.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses patient lifts. Applicable Procedure Codes: E0621, E0630, E0635, E0636, E0639, E0640, E1035, E1036.
Last Published 06.01.2023
Effective Date: 08.01.2023 – This policy addresses patient lifts. Applicable Procedure Codes: E0621, E0630, E0635, E0636, E0639, E0640, E1035, E1036.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses patient lifts. Applicable Procedure Codes: E0621, E0630, E0635, E0636, E0639, E0640, E1035, E1036.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses patient lifts. Applicable Procedure Codes: E0621, E0630, E0635, E0636, E0639, E0640, E1035, E1036.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses patient lifts. Applicable Procedure Codes: E0621, E0630, E0635, E0636, E0639, E0640, E1035, E1036.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses surgical repair of pectus excavatum and pectus carinatum. Applicable Procedure Codes: 21740, 21742, 21743.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses surgical repair of pectus excavatum and pectus carinatum. Applicable Procedure Codes: 21740, 21742, 21743.
Last Published 07.01.2023
Effective Date: 09.01.2023 – This policy addresses surgical repair of pectus excavatum and pectus carinatum. Applicable Procedure Codes: 21740, 21742, 21743.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses surgical repair of pectus excavatum and pectus carinatum. Applicable Procedure Codes: 21740, 21742, 21743.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses surgical repair of pectus excavatum and pectus carinatum. Applicable Procedure Codes: 21740, 21742, 21743.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses surgical repair of pectus excavatum and pectus carinatum. Applicable Procedure Codes: 21740, 21742, 21743.
Last Published 04.01.2024
This policy addresses the reporting of pediatric and neonatal critical and intensive care services, Current Procedural Terminology (CPT®) codes 99468-99476 and 99477-99480, based on instruction from the American Medical Association (AMA) CPT book.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses pediatric gait trainers and standing systems. Applicable Procedure Codes: E0637, E0638, E0641, E0642, E8000, E8001, E8002.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses pediatric gait trainers and standing systems. Applicable Procedure Codes: E0637, E0638, E0641, E0642, E8000, E8001, E8002.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses pediatric gait trainers and standing systems. Applicable Procedure Codes: E0637, E0638, E0641, E0642, E8000, E8001, E8002.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses pediatric gait trainers and standing systems. Applicable Procedure Codes: E0637, E0638, E0641, E0642, E8000, E8001, E8002.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses pediatric gait trainers and standing systems. Applicable Procedure Codes: E0637, E0638, E0641, E0642, E8000, E8001, E8002.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses pediatric gait trainers and standing systems. Applicable Procedure Codes: E0637, E0638, E0641, E0642, E8000, E8001, E8002.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses pediatric gait trainers and standing systems. Applicable Procedure Codes: E0637, E0638, E0641, E0642, E8000, E8001, E8002.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses pediatric gait trainers and standing systems. Applicable Procedure Codes: E0637, E0638, E0641, E0642, E8000, E8001, E8002.
Last Published 06.01.2024
This policy addresses percutaneous coronary intervention (PCI). Applicable Procedure Codes: 92920, 92921, 92924, 92925, 92928, 92929, 92933, 92934, 92937, 92938, 92941, 92943, 92944, 92973, 92974, 92975, 92978, 92979, 93571, 93572, C9600, C9601, C9602, C9603, C9604, C9605, C9606, C9607, C9608.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses percutaneous neuroablation for the treatment of severe cancer pain and trigeminal neuralgia. Applicable Procedure Codes: 64600, 64605, 64610, 64620, 64640.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses percutaneous neuroablation for the treatment of severe cancer pain and trigeminal neuralgia. Applicable Procedure Codes: 64600, 64605, 64610, 64620, 64640.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses percutaneous neuroablation for the treatment of severe cancer pain and trigeminal neuralgia. Applicable Procedure Codes: 64600, 64605, 64610, 64620, 64640.
Last Published 06.01.2024
This policy addresses percutaneous minimally invasive fusion/stabilization of the sacroiliac joint for the treatment of back pain. Applicable Procedure Code: 27279.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses percutaneous patent foramen ovale closure for the prevention of recurrent ischemic stroke. Applicable Procedure Code: 93580.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses percutaneous patent foramen ovale closure for the prevention of recurrent ischemic stroke. Applicable Procedure Code: 93580.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses percutaneous patent foramen ovale closure for the prevention of recurrent ischemic stroke. Applicable Procedure Code: 93580.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses percutaneous patent foramen ovale closure for the prevention of recurrent ischemic stroke. Applicable Procedure Code: 93580.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses percutaneous patent foramen ovale closure for the prevention of recurrent ischemic stroke. Applicable Procedure Code: 93580.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses percutaneous patent foramen ovale closure for the prevention of recurrent ischemic stroke. Applicable Procedure Code: 93580.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses percutaneous patent foramen ovale closure for the prevention of recurrent ischemic stroke. Applicable Procedure Code: 93580.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses percutaneous patent foramen ovale closure for the prevention of recurrent ischemic stroke. Applicable Procedure Code: 93580.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses percutaneous patent foramen ovale closure for the prevention of recurrent ischemic stroke. Applicable Procedure Code: 93580.
Last Published 06.01.2024
This policy addresses percutaneous insertion of an endovascular cardiac (ventricular) assist device. Applicable Procedure Codes: 33990, 33991, 33992, 33993, 33995, 33997.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses percutaneous vertebroplasty and kyphoplasty. Applicable Procedure Codes: 22510, 22511, 22512, 22513, 22514, 22515.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses percutaneous vertebroplasty and kyphoplasty for treating spinal pain. Applicable Procedure Codes: 22510, 22511, 22512, 22513, 22514, 22515.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses percutaneous vertebroplasty and kyphoplasty for treating spinal pain. Applicable Procedure Codes: 22510, 22511, 22512, 22513, 22514, 22515.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses percutaneous vertebroplasty and kyphoplasty for treating spinal pain. Applicable Procedure Codes: 22510, 22511, 22512, 22513, 22514, 22515.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses percutaneous vertebroplasty and kyphoplasty for treating spinal pain. Applicable Procedure Codes: 22510, 22511, 22512, 22513, 22514, 22515.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses percutaneous vertebroplasty and kyphoplasty for treating spinal pain. Applicable Procedure Codes: 22510, 22511, 22512, 22513, 22514, 22515.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses percutaneous vertebroplasty and kyphoplasty for treating spinal pain. Applicable Procedure Codes: 22510, 22511, 22512, 22513, 22514, 22515.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses percutaneous vertebroplasty and kyphoplasty for treating spinal pain. Applicable Procedure Codes: 22510, 22511, 22512, 22513, 22514, 22515.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses percutaneous vertebroplasty and kyphoplasty for treating spinal pain. Applicable Procedure Codes: 22510, 22511, 22512, 22513, 22514, 22515.
Last Published 04.19.2024
This guideline addresses psychological assessments and interventions for persons with disabilities.
Last Published 02.01.2024
Effective 02.01.2024 – This policy addresses pervasive developmental disorders and autism spectrum disorder, including assessment, testing, coordination of care, referral for consultation/evaluation, therapies, treatment programs, and prescription drugs.
Last Published 02.01.2024
Effective 02.01.2024 – This policy addresses pervasive developmental disorders and autism spectrum disorder, including assessment, coordination of care, applied behavioral analysis, behavior training/management/modification, speech/occupational/physical therapy, medications/supplements, and routine laboratory testing.
Last Published 02.01.2024
Effective 02.01.2024 – This policy addresses pervasive developmental disorders and autism spectrum disorder, including assessment, coordination of care, referral for consultation/evaluation, medically necessary neuro-developmental therapies, speech/occupational/physical therapy, and applied behavioral analysis.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses pharmacogenetic multi-gene panel testing. Applicable Procedure Codes: 0029U, 0078U, 0173U, 0175U, 0345U, 0347U, 0348U, 0349U, 0350U, 0380U, 0392U, 0411U, 0419U, 0432U, 0434U, 0438U, 81418, 81479.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses pharmacogenetic multi-gene panel testing. Applicable Procedure Codes: 0029U, 0078U, 0173U, 0175U, 0345U, 0347U, 0348U, 0349U, 0350U, 0380U, 0392U, 0411U, 0419U, 0423U, 0434U, 0438U, 81418, 81479.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of pharmacogenetic multi-gene panel testing for genetic polymorphisms. Applicable Procedure Codes: 0029U, 0078U, 0173U, 0175U, 0345U, 0347U, 0348U, 0349U, 0350U, 0380U, 0392U, 0411U, 0419U, 0423U, 0434U, 0438U, 81418, 81479.
Last Published 06.01.2024
This policy addresses pharmacogenomics testing (PGx). Applicable Procedure Codes: 0029U, 0030U, 0031U, 0032U, 0033U, 0034U, 0392U, 0423U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, 0076U, 0117U, 0173U, 0175U, 0193U, 0286U, 0345U, 0380U, 0411U, 0419U, 81220, 81225, 81226, 81227, 81230, 81231, 81232, 81247, 81283, 81306, 81328, 81335, 81346, 81350, 81355, 81374, 81377, 81381, 81383, 81418.
Last Published 04.19.2024
This guideline provides information and guidance on the types and amounts of physical activity that provide substantial health benefits.
Last Published 04.01.2024
This policy describes reimbursement for Physical Medicine and Rehabilitation Therapy CPT/HCPCS codes containing a time element. These services are referred to as “timed codes” within the policy. Note: In alignment with the Centers for Medicare and Medicaid Services (CMS), at least eight minutes of therapy services must be performed to meet the minimum time qualification to bill one 15 minute unit.
Last Published 01.24.2023
This policy describes reimbursement for timed therapeutic services. These services are referred to as “timed codes” within the policy.
Last Published 01.26.2024
This policy describes how UnitedHealthcare Community Plan aligns with CMS and reduces reimbursement for the PE portions of certain therapy procedures that share these components when those services are the secondary or subsequent procedures provided on a single date of service by the Same Group Physician and/or Other Health Care Professional.
Last Published 04.01.2024
There are some physical medicine and rehabilitation therapy procedures that are frequently reported together on the same date of service. Some of the elements that comprise these services, referred to as Practice Expense (PE) by the Centers for Medicare and Medicaid Services (CMS), are duplicative. These duplicated PE elements include cleaning the room and equipment; education, instruction, counseling and coordinating home care; greeting the patient and providing the gown; obtaining measurements (e.g., range of motion); post-therapy patient assistance; the multispecialty visit pack. R0121
Last Published 04.01.2024
This policy describes which codes will and will not be reimbursed for physical and occupational therapy evaluations, evaluation and management services and the use of the Healthcare Common Procedure Coding System (HCPCS) modifiers GO, GP, CO and CQ.
Last Published 11.14.2022
This policy describes reimbursement for timed therapeutic services (Current Procedural Terminology [CPT] codes 97032, 97033, 97034, 97035, 97036, 97110, 97112, 97113, 97116, 97124, 97140, 97530, 97533, 97535, 97537, 97542, 97750, 97755, 97760, 97761,97763, and Healthcare Common Procedure Coding System [HCPCS] codes G0515, G0237, G0238 and S8948).
Last Published 05.01.2024
Effective 05.01.2024 – This policy addresses physician care (primary care physician, provider and specialist) diagnostic, consultation, and treatment services and referred specialist services.
Last Published 05.01.2024
Effective 05.01.2024 – This policy addresses physician care (primary care physician, provider and specialist) diagnostic, consultation, and treatment services and referred specialist services.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses plagiocephaly and craniosynostosis treatment. Applicable Procedure Codes: D5924, L0112, L0113, S1040.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of cranial orthotic devices for treating infants following craniosynostosis surgery or for nonsynostotic (nonfusion) deformational or positional plagiocephaly. Applicable Procedure Codes: D5924, L0112, L0113, S1040.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of cranial orthotic devices for treating infants following craniosynostosis surgery or for nonsynostotic (nonfusion) deformational or positional plagiocephaly. Applicable Procedure Codes: D5924, L0112, L0113, S1040.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of cranial orthotic devices for treating infants following craniosynostosis surgery or for nonsynostotic (nonfusion) deformational or positional plagiocephaly. Applicable Procedure Codes: L0112, L0113, S1040.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of cranial orthotic devices for treating infants following craniosynostosis surgery or for nonsynostotic (nonfusion) deformational or positional plagiocephaly. Applicable Procedure Codes: D5924, L0112, L0113, S1040.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of cranial orthotic devices for treating infants following craniosynostosis surgery or for nonsynostotic (nonfusion) deformational or positional plagiocephaly. Applicable Procedure Codes: D5924, L0112, L0113, S1040.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of cranial orthotic devices for treating infants following craniosynostosis surgery or for nonsynostotic (nonfusion) deformational or positional plagiocephaly. Applicable Procedure Codes: D5924, L0112, L0113, S1040.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of cranial orthotic devices for treating infants following craniosynostosis surgery or for nonsynostotic (nonfusion) deformational or positional plagiocephaly. Applicable Procedure Codes: D5924, L0112, L0113, S1040.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of cranial orthotic devices for treating infants following craniosynostosis surgery or for nonsynostotic (nonfusion) deformational or positional plagiocephaly. Applicable Procedure Codes: 21175, D5924, L0112, L0113, S1040.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of cranial orthotic devices for treating infants following craniosynostosis surgery or for nonsynostotic (nonfusion) deformational or positional plagiocephaly. Applicable Procedure Codes: D5924, L0112, L0113, S1040.
Last Published 06.01.2024
This policy addresses platelet rich plasma injections/applications for the treatment of musculoskeletal injuries or joint conditions. Applicable Procedure Codes: M0076, P9020.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses pneumatic compression devices. Applicable Procedure Codes: A4600, E0650, E0651, E0652, E0655, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673, E0675, E0676.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses pneumatic compression devices. Applicable Procedure Codes: A4600, E0650, E0651, E0652, E0655, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673, E0675, E0676.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses pneumatic compression devices. Applicable Procedure Codes: A4600, E0650, E0651, E0652, E0655, E0660, E0665, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673, E0675, E0676.
Last Published 05.01.2023
Effective Date: 06.01.2023 – This policy addresses pneumatic compression devices. Applicable Procedure Codes: A4600, E0650, E0651, E0652, E0655, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673, E0675, E0676.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses pneumatic compression devices. Applicable Procedure Codes: A4600, E0650, E0651, E0652, E0655, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673, E0675, E0676.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses pneumatic compression devices. Applicable Procedure Codes: A4600, E0650, E0651, E0652, E0655, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673, E0675, E0676.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses pneumatic, advanced intermittent pneumatic and intermittent limb compression devices. Applicable Procedure Codes: A4600, E0650, E0651, E0652, E0655, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673, E0675, E0676.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses pneumatic and intermittent limb compression devices. Applicable Procedure Codes: A4600, E0650, E0651, E0652, E0655, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673, E0675, E0676.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses pneumatic and intermittent limb compression devices. Applicable Procedure Codes: A4600, E0650, E0651, E0652, E0655, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, E0672, E0673, E0675, E0676.
Last Published 06.01.2024
This policy addresses porcine (pig) skin dressings and gradient pressure dressings. Applicable Procedure Codes: A2001, A2004, A2008, A6501, A6502, A6503, A6504, A6505, A6506, A6507, A6508, A6509, A6510, A6511, A6512, A6513, A6530, A6531, A6532, A6533, A6534, A6535, A6536, A6537, A6538, A6539, A6540, A6541, A6544, A6545, A6549, Q4102, Q4103, Q4118, Q4124, Q4135, Q4136, Q4166, Q4175, Q4195, Q4196, Q4197, Q4203.
Last Published 06.01.2024
This policy addresses positron emission tomography (PET) scans.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses post mastectomy surgery.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses post mastectomy surgery.
Last Published 06.01.2024
This policy addresses computerized dynamic posturography (CDP) for the treatment of neurologic disease and inherited disorders, peripheral vestibular disorders, and disequilibrium in the aging/elderly. Applicable Procedure Code: 92548.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses prefabricated crowns. Applicable Procedure Codes: D2928, D2929, D2930, D2931, D2932, D2933, D2934.
Last Published 07.01.2023
Effective Date: 08.01.2023 – This policy addresses preimplantation genetic testing (PGT) and related services. Applicable Procedure Codes: 0254U, 58970, 58974, 76948, 81228, 81229, 81349, 81479, 89250, 89251, 89253, 89254, 89255, 89257,89258, 89260, 89261, 89264, 89268, 89272, 89280, 89281, 89290, 89291, 89342, 89352, S4011, S4015, S4016, S4022, S4037.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses preimplantation genetic testing (PGT) and related services. Applicable Procedure Codes: 0254U, 0396U, 58970, 58974, 76948, 81228, 81229, 81349, 81479, 89250, 89251, 89253, 89254, 89255, 89257,89258, 89260, 89261, 89264, 89268, 89272, 89280, 89281, 89290, 89291, 89342, 89352, S4011, S4015, S4016, S4022, S4037.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses preimplantation genetic testing (PGT) and related services. Applicable Procedure Codes: 0254U, 0396U, 58970, 58974, 76948, 81228, 81229, 81349, 81479, 89250, 89251, 89253, 89254, 89255, 89257, 89258, 89260, 89261, 89264, 89268, 89272, 89280, 89281, 89290, 89291, 89342, 89352, S4011, S4015, S4016, S4022, S4037.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses preimplantation genetic testing (PGT) and related services. Applicable Procedure Codes: 0254U, 0396U, 58970, 58974, 76948, 81228, 81229, 81349, 81479, 89250, 89251, 89253, 89254, 89255, 89257,89258, 89260, 89261, 89264, 89268, 89272, 89280, 89281, 89290, 89291, 89342, 89352, S4011, S4015, S4016, S4022, S4037.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses preimplantation genetic testing (PGT) and related services. Applicable Procedure Codes: 0254U, 0396U, 58970, 58974, 76948, 81228, 81229, 81349, 81479, 89250, 89251, 89253, 89254, 89255, 89257,89258, 89260, 89261, 89264, 89268, 89272, 89280, 89281, 89290, 89291, 89342, 89352, S4011, S4015, S4016, S4022, S4037.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses preimplantation genetic testing (PGT) and related services. Applicable Procedure Codes: 0254U, 0396U, 58970, 58974, 76948, 81228, 81229, 81349, 81479, 89250, 89251, 89253, 89254, 89255, 89257,89258, 89260, 89261, 89264, 89268, 89272, 89280, 89281, 89290, 89291, 89342, 89352, S4011, S4015, S4016, S4022, S4037.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses prescribed pediatric extended care (PPEC). Applicable Procedure Codes: T1025, T1026.
Last Published 01.01.2024
Effective 01.01.2024 – This policy addresses preventive health care services.
Last Published 01.01.2024
Effective 01.01.2024 – This policy addresses preventive health care services.
Last Published 02.02.2024
Preventive Medicine Services [Current Procedural Terminology (CPT®) codes 99381-99387, 99391-99397, Healthcare Common Procedure Coding System (HCPCS) code G0402] include annual physical and well child examinations, usually separate from disease-related diagnoses. Occasionally, an abnormality is encountered or a pre-existing problem is addressed during the Preventive visit, and significant elements of related Evaluation and Management (E/M) services are provided during the same visit. When this occurs, UnitedHealthcare Community Plan will reimburse the Preventive Medicine service plus the following problem-oriented E/M service codes when that code is appended with modifier 25. If the problem-oriented service is minor, or if the code is not submitted with modifier 25 appended, it will not be reimbursed. When a Preventive Medicine service and other E/M services are provided during the same visit, only the Preventive Medicine service will be reimbursed. Screening services include cervical cancer screening; pelvic and breast examination; prostate cancer screening; digital rectal examination; and obtaining, preparing and conveyance of a Papanicolaou smear to the laboratory. These screening procedures are included in (and are not separately reimbursed from) the Preventive Medicine service rendered on the same day for members age 22 years and over. Prolonged services are included in (and not separately reimbursed from) Preventive Medicine codes. Counseling services are included in (and not separately reimbursed from) Preventive Medicine codes. Medical Nutrition Therapy services are included in (and not separately reimbursed from) Preventive Medicine codes. (99172) Visual function screening is included in the Preventive Medicine Services and not separately reimbursable.
Last Published 05.09.2024
Preventive Medicine Services [Current Procedural Terminology (CPT®) codes 99381-99387, 99391-99397, Healthcare Common Procedure Coding System (HCPCS) code G0402] are comprehensive in nature, reflect an age and gender appropriate history and examination, and include counseling, anticipatory guidance, and risk factor reduction interventions, usually separate from disease-related diagnoses.R0013
Last Published 04.19.2024
This guideline outlines the recommendations for preventive pediatric care from infancy to adolescence.
Last Published 04.19.2024
This guideline addresses a collection of evidence-based recommendations on clinical preventive services such as screenings, counseling services, and preventive medications.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses private duty nursing (PDN) and extended home health (EHH) services. Applicable Procedure Codes: S9123, S9124, T1000, T1001.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses private duty nursing services. Applicable Procedure Codes: S9123, S9124, T1000, T1001, T1002, T1003, T1030, T1031.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses private duty nursing services. Applicable Procedure Code: T1000.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses private duty nursing services. Applicable Procedure Codes: S9123, S9124, T1000, T1001, T1002, T1003, T1030, T1031.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses private duty nursing services. Applicable Procedure Codes: S9123, S9124, T1000, T1001, T1002, T1003, T1030, T1031.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses private duty nursing services. Applicable Procedure Codes: S9123, S9124, T1000, T1002, T1003, T1030, T1031.
Last Published 08.01.2023
Effective Date: 09.01.2023 – This policy addresses private duty nursing services. Applicable Procedure Codes: T1000, T1002, S9123, S9124.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses private duty nursing (PDN) services. Applicable Procedure Code: T1000, T1002, S9123, S9124.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses private duty nursing services. Applicable Procedure Code: S9123, S9124, T1000, T1001.
Last Published 01.19.2024
Effective Date: 01.01.2024 – This policy addresses private duty nursing services. Applicable Procedure Code: T1000.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses private duty nursing (PDN) services. Applicable Procedure Code: T1000
Last Published 05.02.2024
UnitedHealthcare Medicare Advantage will reimburse CPT and HCPCS codes when reported with an appropriate Placeof Service (POS). R9029
Last Published 04.01.2024
According to the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS), a modifier provides the means to report or indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code. Flag: MOD, MODDN, MODAT
Last Published 05.01.2024
This policy addresses the appropriate use of modifiers with individual CPT and HCPCS procedure codes. R9030
Last Published 05.30.2023
According to the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS), a modifier provides the means to report or indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.
Last Published 04.01.2024
This policy describes the reimbursement methodology for Current Procedural Terminology (CPT®) and Healthcare Common Procedural Coding System (HCPCS) codes based on the Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS) Relative Value File, Professional Component (PC)/Technical Component (TC) Indicators
Last Published 02.20.2024
This policy describes the reimbursement methodology for Current Procedural Terminology (CPT®) and Healthcare Common Procedural Coding System (HCPCS) codes based on the Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS) Relative Value File, Professional Component (PC)/Technical Component (TC) Indicators.
Last Published 04.30.2024
This policy describes the reimbursement methodology for Current Procedural Terminology (CPT®) and Healthcare Common Procedural Coding System (HCPCS) codes based on the Centers for Medicare and Medicaid Services (CMS). R9031
Last Published 11.23.2022
This policy identifies when UnitedHealthcare will separately reimburse physicians or other qualified health care professionals for Prolonged Services when reported in conjunction with companion Evaluation & Management (E/M) codes or other services.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses prolotherapy and platelet rich plasma. Applicable Procedure Codes: 0232T, G0460, G0465, M0076, P9020.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses prolotherapy and platelet rich plasma. Applicable Procedure Codes: 0232T, G0460, G0465, M0076, P9020.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses prolotherapy and platelet rich plasma. Applicable Procedure Codes: 0232T, G0460, G0465, M0076, P9020.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses prolotherapy and platelet rich plasma. Applicable Procedure Codes: 0232T, G0460, G0465, M0076, P9020.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses prolotherapy and platelet rich plasma. Applicable Procedure Codes: 0232T, G0460, G0465, M0076, P9020.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses prolotherapy and platelet rich plasma. Applicable Procedure Codes: 0232T, G0460, G0465, M0076, P9020.
Last Published 11.01.2023
Effective Date: 11.01.2023– This policy addresses prolotherapy and platelet rich plasma. Applicable Procedure Codes: 0232T, G0460, G0465, M0076, P9020.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses prolotherapy and platelet rich plasma. Applicable Procedure Codes: 0232T, G0460, G0465, M0076, P9020.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses prolotherapy and platelet rich plasma. Applicable Procedure Codes: 0232T, G0460, G0465, M0076, P9020.
Last Published 06.01.2024
This policy addresses services and procedures for the diagnosis and treatment of prostate conditions and related impotence treatment. Applicable Codes: 37243, 52441, 52442, 52601, 52630, 52648, 53855, 55040, 55041, 55060, 55500, 55700, 55801, 55874, 55875, 55876, C9739, C9740, L8699.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses prostrate surgeries and interventions, including transurethral ablation, cryoablation, surgical prostatectomy, prostatic urethral lift (PUL), high-energy water vapor thermotherapy, and transperineal placement of biodegradable material. Applicable Procedure Codes: 0421T, 0582T, 0655T, 0738T, 0739T, 37243, 52441, 52442, 53850, 53852, 53854, 53855, 55866, 55873, 55874.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses prostate surgeries and interventions, including transurethral ablation, cryoablation, surgical prostatectomy, prostatic urethral lift (PUL), high-energy water vapor thermotherapy, and transperineal placement of biodegradable material. Applicable Procedure Codes: 0421T, 0582T, 0655T, 0714T, 0738T, 0739T, 37243, 52441, 52442, 53850, 53852, 53854, 53855, 55866, 55867, 55873, 55874.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses prostate surgeries and interventions, including transurethral ablation, cryoablation, surgical prostatectomy, prostatic urethral lift (PUL), high-energy water vapor thermotherapy, and transperineal placement of biodegradable material. Applicable Procedure Codes: 0421T, 0582T, 0655T, 0738T, 0739T, 37243, 52441, 52442, 53850, 53852, 53854, 53855, 55866, 55867, 55873, 55874.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses proton beam radiation therapy. Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses proton beam radiation therapy. Applicable Procedure Codes: G6015, G6016, G6017, 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses proton beam radiation therapy. Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses proton beam radiation therapy. Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses proton beam radiation therapy. Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses proton beam radiation therapy. Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses proton beam radiation therapy. Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses proton beam radiation therapy. Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses proton beam radiation therapy. Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses proton beam radiation therapy. Applicable Procedure Codes: 77301, 77338, 77385, 77386, 77387, 77520, 77522, 77523, 77525, G6015, G6016, G6017.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses outpatient hospital facility-based intravenous medication infusion. Applicable Procedure Codes: 90283, 90284, J0129, J1426, J1427, J1428, J1429, J1459, J1551, J1554, J1555, J1556, J1557, J1558, J1559, J1561, J1566, J1568, J1569, J1572, J1575, J1576, J1599, J1602, J1745, J1576, J1599, J1602, J1745, J3245, J3262, J3380, J3590, Q5103, Q5104, Q5121.
Last Published 06.01.2023
Effective Date: 07.01.2023 – This policy addresses outpatient hospital facility-based intravenous medication infusion.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses outpatient hospital facility-based intravenous medication infusion.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses outpatient hospital facility-based intravenous medication infusion. Applicable Procedure Codes: 90283, 90284, C9399, J0129, J0180, J0217, J0218, J0219, J0221, J1203, J1322, J1426, J1427, J1428, J1429, J1458, J1459, J1551, J1554, J1555, J1556, J1557, J1558, J1559, J1561, J1566, J1568, J1569, J1572, J1575, J1599, J1602, J1743, J1745, J1931, J2327, J2508, J2840, J3245, J3262, J3380, J3397, J3490, J3590, Q5103, Q5104, Q5121.
Last Published 02.02.2024
Consistent with the Affordable Care Act administered through the Centers for Medicare and Medicaid Services (CMS), UnitedHealthcare Community Plan will implement the requirements related to the Provider Preventable Conditions initiative which includes: 1) adjustment of reimbursement for Health Care Acquired Conditions (HCAC), 2) POA indicator requirement 3) no reimbursement for Never Events and 4) Other Provider Preventable Conditions (OPPC) as defined by any additional State Regulations that are in place that expand or further define the CMS regulations.
Last Published 11.23.2022
Consistent with the Affordable Care Act administered through the Centers for Medicare and Medicaid Services (CMS),UnitedHealthcare Community Plan will implement the requirements related to the Provider Preventable Conditionsinitiative which includes: 1) adjustment of reimbursement for Health Care Acquired Conditions (HCAC), 2) Present OnAdmission (POA) indicator requirement 3) no reimbursement for Never Events and 4) Other Provider PreventableConditions (OPPC) as defined by any additional State Regulations that are in place that expand or further define the CMSregulations.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Qalsody™ (tofersen) for the treatment of amyotrophic lateral sclerosis (ALS). Applicable Procedure Code: J1304.
Last Published 05.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Qalsody® (tofersen) for the treatment of amyotrophic lateral sclerosis (ALS). Applicable Procedure Code: J1304.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Qalsody® (tofersen) for the treatment of amyotrophic lateral sclerosis (ALS). Applicable Procedure Code: J1304.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Qalsody® (tofersen) for the treatment of amyotrophic lateral sclerosis (ALS). Applicable Procedure Code: J1304.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Qalsody® (tofersen) for the treatment of amyotrophic lateral sclerosis (ALS). Applicable Procedure Code: J1304.
Last Published 06.01.2024
This policy addresses high-dose rate electronic brachytherapy, implantable beta-emitting microspheres for treatment of malignant tumors, image guided radiation therapy (IGRT), special/associated services, standard radiation therapy (2D/3D), proton beam therapy (PBT), intensity modulated radiation therapy (IMRT), stereotactic radiosurgery/stereotactic body radiation therapy (SBRT), tumor treatment field therapy (TTFT), intraoperative hyperthermic intraperitoneal chemotherapy, and intraoperative radiation treatment (IORT) . Applicable Procedure Codes: 0394T, 0395T, 0398T, 20985, 37243, 77014, 77280, 77330, 77331, 77339, 77370, 77371, 77372, 77373, 77385, 77386, 77387, 77399, 77401, 77402, 77407, 77412, 77424, 77425, 77469, 77470, 77520, 77522, 77523, 77525, 79445, A4555, E0766, G0339, G0340, G6001, G6002, G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014, G6015, G6016, G6017.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses radiation therapy fractionation, image-guided radiation therapy (IGRT), and special radiation therapy services.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses radiation therapy fractionation, image-guided radiation therapy (IGRT), and special radiation therapy services. Applicable Procedure Codes: 77014, 77301, 77331, 77370, 77385, 77386, 77387, 77399, 77401, 77402, 77407, 77412, 77470, 77520, 77522, 77523, 77525, G6001, G6002, G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014, G6015, G6016, G6017.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses radiation therapy fractionation, image-guided radiation therapy (IGRT), and special radiation therapy services. Applicable Procedure Codes: 77014, 77331, 77370, 77385, 77386, 77387, 77399, 77401, 77402, 77407, 77412, 77470, 77520, 77522, 77523, 77525, G6001, G6002, G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014, G6015, G6016, G6017.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses radiation therapy fractionation, image-guided radiation therapy (IGRT), and special radiation therapy services. Applicable Procedure Codes: 77014, 77331, 77370, 77385, 77386, 77387, 77399, 77401, 77402, 77407, 77412, 77470, 77520, 77522, 77523, 77525, G6001, G6002, G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014, G6015, G6016, G6017.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses radiation therapy fractionation, image-guided radiation therapy (IGRT), and special radiation therapy services.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses radiation therapy fractionation, image-guided radiation therapy (IGRT), and special radiation therapy services. Applicable Procedure Codes: 77014, 77331, 77370, 77385, 77386, 77387, 77399, 77401, 77402, 77407, 77412, 77470, 77520, 77522, 77523, 77525, G6001, G6002, G6003, G6004, G6005, G6006, G6007, G6008, G6009, G6010, G6011, G6012, G6013, G6014, G6015, G6016, G6017.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Radicava® (edaravone) for the treatment of amyotrophic lateral sclerosis (ALS). Applicable Procedure Code: J1301.
Last Published 04.01.2023
Effective Date: 04.01.2023 – This policy addresses the use of Radicava® (edaravone) for the treatment of amyotrophic lateral sclerosis (ALS). Applicable Procedure Code: J1301.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Radicava® (edaravone) for the treatment of amyotrophic lateral sclerosis (ALS). Applicable Procedure Code: J1301.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Radicava® (edaravone) for the treatment of amyotrophic lateral sclerosis (ALS). Applicable Procedure Code: J1301.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Radicava® (edaravone) for the treatment of amyotrophic lateral sclerosis (ALS). Applicable Procedure Code: J1301.
Last Published 01.12.2024
This policy identifies circumstances in which UnitedHealthcare Community Plan will reimburse physicians or other health care professionals for radioallergosorbent (RAST) type tests as part of an allergy evaluation.
Last Published 06.01.2024
This policy addresses diagnostic radiological services (inpatient and outpatient). Applicable Procedure Codes: 76376, 76377, 78012, 78013, 78014, 78015, 78016, 78018, 78070, 78071, 78072, 78075, 78099, 78199, 78226, 78227, 78299, 78399, 78429, 78430, 78431, 78432, 78433, 78434, 78451, 78452, 78459, 78469, 78491, 78492, 78494, 78499, 78579, 78580, 78582, 78597, 78598, 78599, 78608, 78699, 78799, 78800, 78801, 78802, 78803, 78804, 78811, 78812, 78813, 78814, 78815, 78816, 78830, 78831, 78832, 78999.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses radiopharmaceuticals and contrast media administered by eviCore healthcare.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses Reblozyl® (luspatercept-aamt) for the treatment of anemia in adult patients with beta thalassemia and symptomatic anemia in patients with myelodysplastic syndromes or myelodysplastic/myeloproliferative neoplasms. Applicable Procedure Code: J0896.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses Reblozyl® (luspatercept-aamt) for the treatment of anemia in adult patients with beta thalassemia and symptomatic anemia in patients with myelodysplastic syndromes or myelodysplastic/myeloproliferative neoplasms. Applicable Procedure Code: J0896.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses Reblozyl® (luspatercept-aamt) for the treatment of anemia in adult patients with beta thalassemia and symptomatic anemia in patients with myelodysplastic syndromes or myleodysplastic/myeloproliferative neoplasms. Applicable Procedure Code: J0896.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses Reblozyl® (luspatercept-aamt) for the treatment of anemia in adult patients with beta thalassemia and symptomatic anemia in patients with myelodysplastic sydromes or myleodysplastic/myeloproliferative neoplasms. Applicable Procedure Code: J0896.
Last Published 09.25.2023
UnitedHealthcare Medicare Advantage uses this policy to determine whether CPT and/or HCPCS codes reported together by the Same Individual Physician or Health Care Professional for the same member on the same date of service are eligible for separate reimbursement. UnitedHealthcare Medicare Advantage will not reimburse services determined to be Incidental, Mutually Exclusive, Transferred, or Unbundled to a more comprehensive service unless the codes are reported with an appropriate modifier.
Last Published 04.01.2024
UnitedHealthcare sources its Rebundling edits to methodologies used and recognized by third party authorities. R0056A Flag: UED, UES, UER, UID, UIS, UUD, UUR, UUS, HED, HER, HES, HID, HIR, UIR, HIS, HUD, HUR, HUS, REB, REBAR, TRA, HRB
Last Published 10.02.2023
According to the Centers for Medicare and Medicaid Services (CMS), medical and surgical procedures should be reported with the Current Procedural Terminology (CPT®) or Healthcare Common Procedure Coding System (HCPCS) codes that most comprehensively describe the services performed. Unbundling occurs when multiple procedure codes are billed for a group of procedures that are covered by a single comprehensive code. For the purpose of this policy, the same individual physician or health care professional is the same individual rendering health care services reporting the same Federal Tax Identification number.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Rebyota™ (fecal microbiota, live-jslm) for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: G0455, J1440.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of Rebyota™ (fecal microbiota, live-jslm) for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: G0455, J1440.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Rebyota™ (fecal microbiota, live-jslm) for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: G0455, J1440.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Rebyota™ (fecal microbiota, live-jslm) for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: G0455, J1440.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Rebyota™ (fecal microbiota, live-jslm) for prevention of the recurrence of clostridioides difficile infection (CDI). Applicable Procedure Codes: G0455, J1440.
Last Published 10.23.2023
As defined in the Current Procedural Terminology (CPT®) book, under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. Under these circumstances the service provided can be identified by its usual procedure number and the addition of Modifier 52 (Reduced Services), signifying that the service is reduced. This provides a means of reporting Reduced Services without disturbing the identification of the basic service. Modifier 52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. It is not appropriate to use Modifier 52 if a portion of the intended procedure was completed and a code exists which represents the completed portion of the intended procedure.
Last Published 02.09.2024
As defined in the Current Procedural Terminology (CPT®) book, under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional.
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses rehabilitation services, including acute inpatient rehabilitation, outpatient physical and occupational therapy, and speech therapy.
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses rehabilitation services, including acute inpatient rehabilitation, outpatient physical and occupational therapy, and speech therapy.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses complete and partial dentures, complete and partial denture rebase and reline procedures, interim prosthesis, overdentures, tissue conditioning, and repairs and adjustments.
Last Published 04.01.2024
All codes published on the National Physician Fee Schedule (NPFS) by the Centers for Medicare and Medicaid Services (CMS) are assigned a status code. This policy addresses specific codes assigned status code "I" where CMS has indicated a replacement code is available and has assigned a Relative Value Unit (RVU) to the replacement code. R0128
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of repository corticotropin injection (Acthar® Gel) for the treatment of infantile spasm, opsoclonus-myoclonus syndrome, and acute exacerbation of multiple sclerosis (MS). Applicable Procedure Codes: J0801, J0802.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of repository corticotropin injections (Acthar® Gel and Purified Cortophin Gel). Applicable Procedure Codes: J0801, J0802.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of repository corticotropin injections (Acthar® Gel and Purified Cortophin Gel) for the treatment of infantile spasm and opsoclonus-myoclonus syndrome. Applicable Procedure Code: J0800.
Last Published 09.01.2023
Effective Date: 10.01.2023 – This policy addresses the use of repository corticotropin injection (Acthar® Gel) for the treatment of infantile spasm, opsoclonus-myoclonus syndrome, and acute exacerbation of multiple sclerosis (MS). Applicable Procedure Code: J0800.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses the use of repository corticotropin injections for the treatment of infantile spasm, opsoclonus-myoclonus syndrome, and acute exacerbation of multiple sclerosis (MS). Applicable Procedure Codes: J0801, J0802.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of repository corticotropin injection (Acthar® Gel and Purified Cortrophin Gel™) for the treatment of infantile spasm, opsoclonus-myoclonus syndrome, and acute exacerbation of multiple sclerosis (MS). Applicable Procedure Codes: J0801, J0802.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of interleukin-5 (IL-5) antagonists, including Cinqair® (reslizumab), Fasenra® (benralizumab), and Nucala® (mepolizumab). Applicable Procedure Codes: J0517, J2182, J2786.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of interleukin-5 (IL-5) antagonists, including Cinqair® (reslizumab), Fasenra® (benralizumab), and Nucala® (mepolizumab). Applicable Procedure Codes: J0517, J2182, J2786.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of interleukin-5 (IL-5) antagonists, including Cinqair® (reslizumab), Fasenra® (benralizumab), and Nucala® (mepolizumab). Applicable Procedure Codes: J0517, J2182, J2786.
Last Published 11.23.2022
This reimbursement policy applies to services reported using the UB-04 claim form, the 1500 Health Insurance Claim Form (CMS-1500), their electronic equivalents or its successor forms. This policy applies to all products and all network and non-network providers, including hospitals, ambulatory surgical centers, physicians and other qualified health care professionals including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses lysis intranasal synechia, repair of nasal vestibular stenosis or alar collapse, rhinoplasty, rhinophyma, nasal polypectomy, nasal septal swell body reduction, and nasal implants. Applicable Procedure Codes: 30117, 30120, 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465, 30468, 30469, 30560, 30999, 31237, 31242, 31243, L8699.
Last Published 08.01.2023
Effective Date: 10.01.2023 – This policy addresses lysis intranasal synechia, repair of nasal vestibular stenosis or alar collapse, rhinoplasty, rhinophyma, and septal dermatoplasty. Applicable Procedure Codes: 30117, 30120, 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465, 30468, 30560, 30999, 31237, L8699.
Last Published 07.01.2023
Effective Date: 08.01.2023 – This policy addresses lysis intranasal synechia, repair of nasal vestibular stenosis or alar collapse, rhinoplasty, rhinophyma, septal dermatoplasty, and nasal polypectomy. Applicable Procedure Codes: 30117, 30120, 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465, 30468, 30469, 30560, 30999, 31237, L8699.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Riabni® (rituximab-arrx), Rituxan® (rituximab), Ruxience® (rituximab-pvvr), and Truxima® (rituximab-abbs). Applicable Procedure Codes: J3590, J9311, J9312, J999, Q5115, Q5119, Q5123.
Last Published 02.01.2024
Effective Date: 10.01.2023 – This policy addresses the use of Riabni® (rituximab-arrx), Rituxan® (rituximab), Ruxience® (rituximab-pvvr), and Truxima® (rituximab-abbs). Applicable Procedure Codes: J3590, J9311, J9312, J9999. Q5115, Q5119, Q5123.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Riabni® (rituximab-arrx), Rituxan® (rituximab), Ruxience® (rituximab-pvvr), and Truxima® (rituximab-abbs). Applicable Procedure Codes: J9312, Q5115, Q5119, Q5123.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Riabni® (rituximab-arrx), Rituxan® (rituximab), Ruxience® (rituximab-pvvr), and Truxima® (rituximab-abbs). Applicable Procedure Codes: J9311, J9312, Q5115, Q5119, Q5123.
Last Published 07.01.2023
Effective Date: 08.01.2023 – This policy addresses the use of Riabni™ (rituximab-arrx), Rituxan® (rituximab), Ruxience® (rituximab-pvvr), and Truxima® (rituximab-abbs). Applicable Procedure Codes: J9311, J9312, Q5115, Q5119, Q5123.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses the use of Riabni™ (rituximab-arrx), Rituxan® (rituximab), Ruxience® (rituximab-pvvr), and Truxima® (rituximab-abbs). Applicable Procedure Codes: J9311, J9312, Q5115, Q5119, Q5123.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses the use of Onpattro® (patisiran) and Amvuttra® (vutrisiran) for the treatment of polyneuropathy of hereditary transthyretin-mediated (hATTR) amyloidosis. Applicable Procedure Codes: C9399, J0222, J3490, J3590.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses the use of Onpattro® (patisiran) and Amvuttra™ (vutrisiran) for the treatment of polyneuropathy of hereditary transthyretin-mediated (hATTR) amyloidosis. Applicable Procedure Codes: J0222, J0225.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Onpattro® (patisiran) and Amvuttra™ (vutrisiran) for the treatment of polyneuropathy of hereditary transthyretin-mediated (hATTR) amyloidosis. Applicable Procedure Codes: J0222, J0225.
Last Published 11.01.2023
Effective Date: 08.01.2023 – This policy addresses the use of Amvuttra® (vutrisiran) and Onpattro® (patisiran) for the treatment of polyneuropathy of hereditary transthyretin-mediated (hATTR) amyloidosis. Applicable Procedures Code: J0222, J0225.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses the use of Amvuttra® (vutrisiran) and Onpattro® (patisiran) for the treatment of polyneuropathy of hereditary transthyretin-mediated (hATTR) amyloidosis. Applicable Procedures Codes: C9399, J0222, J3490, J3590.
Last Published 04.02.2024
The Health Care Common Procedure Coding System (HCPCS) code S2900 (Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)) describes a computer-aided tool used in performing a specific surgical procedure. R0114
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Roctavian™ (valoctocogene roxaparvovec-rvox) for the treatment of Hemophilia A (factor VIII Deficiency). Applicable Procedure Code: J1412.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Roctavian™ (valoctocogene roxaparvovec-rvox) for the treatment of Hemophilia A (factor VIII Deficiency). Applicable Procedure Code: J1412.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Ryplazim® (plasminogen, human-tvmh) for the treatment of plasminogen deficiency type 1 (hypoplasminogenemia). Applicable Procedure Code: J2998.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses Ryplazim® (plasminogen, human-tvmh) for the treatment of plasminogen deficiency type 1 (hypoplasminogenemia). Applicable Procedure Code: J2998.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses Ryplazim® (plasminogen, human-tvmh) for the treatment of plasminogen deficiency type 1 (hypoplasminogenemia). Applicable Procedure Codes: J2998, J3490, J3590.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses Ryplazim® (plasminogen, human-tvmh) for the treatment of plasminogen deficiency type 1 (hypoplasminogenemia). Applicable Procedure Code: J2998.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses sacral nerve stimulation for urinary and fecal indications. Applicable Procedure Codes: 0784T, 0785T, 0786T, 0787T, 64561, 64581, 64585, 64590, 64595, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses sacral nerve stimulation for urinary and fecal indications. Applicable Procedure Codes: 0784T, 0785T, 0786T, 0787T, 64561, 64581, 64585, 64590, 64595, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses sacral nerve stimulation for urinary and fecal indications. Applicable Procedure Codes: 0784T, 0785T, 0786T, 0787T, 64561, 64581, 64585, 64590, 64595, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses sacral nerve stimulation for urinary and fecal indications. Applicable Procedure Codes: 0784T, 0785T, 0786T, 0787T, 64561, 64581, 64585, 64590, 64595, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses sacral nerve stimulation for urinary and fecal indications. Applicable Procedure Codes: 0784T, 0785T, 0786T, 0787T, 64561, 64581, 64585, 64590, 64595, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses sacral nerve stimulation for urinary and fecal indications. Applicable Procedure Codes: 0784T, 0785T, 0786T, 0787T, 64561, 64581, 64585, 64590, 64595, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses sacral nerve stimulation for urinary and fecal indications. Applicable Procedure Codes: 0784T, 0785T, 0786T, 0787T, 64561, 64581, 64585, 64590, 64595, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses sacral nerve stimulation for urinary and fecal indications. Applicable Procedure Codes: 64561, 64581, 64585, 64590, 64595, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses sacral nerve stimulation for urinary and fecal indications. Applicable Procedure Codes: 0784T, 0785T, 0786T, 0787T, 64561, 64581, 64585, 64590, 64595, L8679, L8680, L8682, L8685, L8686, L8687, L8688.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses sacroiliac joint (SI) injections. Applicable Procedure Codes: 27096, 27278, 27279, 27280, 64451, G0260.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses sacroiliac joint interventions, including sacroiliac joint injections and sacroiliac joint fusion. Applicable Procedure Codes: 27096, 27278, 27279, 27280, 64451, G0260.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses sacroiliac joint interventions, including sacroiliac joint injections and sacroiliac joint fusion. Applicable Procedure Codes: 0775T, 0809T, 27096, 27279, 27280, 64451, G0260.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses sacroiliac joint interventions, including sacroiliac joint injections and sacroiliac joint fusion. Applicable Procedure Codes: 27278, 27096, 27279, 27280, 64451, G0260.
Last Published 02.01.2024
Effective Date: 11.01.2023 – This policy addresses collection, preparation and analysis of saliva sample for laboratory diagnostic testing and assessment of salivary flow by measurement. Applicable Procedure Codes: D0417, D0418, D0419.
Last Published 04.01.2024
The Same Day/Same Service Policy addresses those instances when a single code should be reported by a physician(s) or other health care professional(s) for multiple medical and/or Evaluation and Management (E/M) services for a patient on a single date of service. R0002 Flag: SUN, SDS, SCC
Last Published 04.01.2024
The Same Day/Same Service Policy addresses those instances when a single code should be reported by a physician(s) or other qualified health care professional(s) for Evaluation and Management (E/M) services for a patient on a single date of service. Generally, a single E/M code should be used to report all services provided for a patient on each given day.
Last Published 12.28.2022
The Same Day/Same Service Policy addresses those instances when a single code should be reported by a physician(s) or other health care professional(s) for multiple medical and/or Evaluation and Management (E/M) services for a patient on a single date of service. Generally, a single E/M code should be used to report all services provided for a patient on each given day. Prolonged services and care plan oversight may be exceptions. (See UnitedHealthcare Community Plan policies entitled Prolonged Services and Care Plan Oversight for more information.)
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses Saphnelo® (anifrolumab-fnia) for the treatment of moderate to severe systemic lupus erythematosus (SLE). Applicable Procedure Code: J0491
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses Scenesse® (afamelanotide) for the treatment of erythropoietic protoporphyria (EPP). Applicable Procedure Code: J7352.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses planned preventive screening colonoscopies performed in a hospital outpatient department. Applicable Procedures Codes: 45378, 45380, 45381, 45384, 45385, G0105, G0121.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses planned preventive screening colonoscopies performed in a hospital outpatient department. Applicable Procedures Codes: 45378, 45380, 45381, 45384, 45385, G0105, G0121.
Last Published 02.01.2024
Effective Date: 08.01.2023 – This policy addresses sealants and preventive resin restoration (PRR). Applicable Procedure Codes: D1351, D1352, D1353.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses medications that are determined to be self-administered and excluded from medical coverage.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses medications that are determined to be self-administered and excluded from medical coverage.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses medications that are determined to be self-administered and excluded from medical coverage.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses medications that are determined to be self-administered and excluded from medical coverage.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses medications that are determined to be self-administered and excluded from medical coverage.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses sensory integration therapy and auditory integration training. Applicable Procedure Code: 97533.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses sensory integration therapy and auditory integration training. Applicable Procedure Code: 97533.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses sensory integration therapy and auditory integration training. Applicable Procedure Code: 97533.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses sensory integration therapy and auditory integration training. Applicable Procedure Code: 97533.
Last Published 03.01.2024
Effective Date: 10.01.2023 – This policy addresses sensory integration therapy and auditory integration training. Applicable Procedure Code: 97533.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses sensory integration therapy and auditory integration training. Applicable Procedure Code: 97533.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses sensory integration therapy and auditory integration training. Applicable Procedure Code: 97533.
Last Published 04.19.2024
This guideline outlines the early management and resuscitation of patients with sepsis or septic shock and includes the definition of sepsis/septic shock.
Last Published 11.14.2022
All codes published on the National Physician Fee Schedule (NPFS) by the Centers for Medicaid Services (CMS) are assigned a status code.
Last Published 04.04.2024
All codes published on the National Physician Fee Schedule (NPFS) by the Centers for Medicare and Medicaid Services (CMS) are assigned a status code. The status code indicates whether the code is separately payable if the service is covered.
Last Published 04.15.2024
All codes published on the National Physician Fee Schedule (NPFS) by the Centers for Medicare and Medicaid Services (CMS) are assigned a status code. The status code indicates whether the code is separately payable if the service is covered. R0124
Last Published 04.01.2024
This policy describes the reimbursement of services rendered by unlicensed residents, interns and medical students as identified by the Healthcare Provider Taxonomy Code reported on the claim. This policy also addresses how reimbursement for services by unlicensed residents, interns and medical students will be considered when billed with an appropriate modifier. R5026
Last Published 07.01.2023
This policy describes the reimbursement of services rendered by unlicensed residents, interns and medical students as identified by the Healthcare Provider Taxonomy Code reported on the claim. This policy also addresses how reimbursement for services by unlicensed residents, interns and medical students will be considered when billed withan appropriate modifier to indicate covered services were rendered under the direction of a Teaching Physician, or without the presence of a Teaching Physician under the Primary Care Exception.
Last Published 04.01.2024
This policy sets forth the requirements for (i) reporting the services provided as “incident-to” a Supervising Health Care Provider in the office or clinic setting and (ii) reporting Split and/or shared evaluation and management services in a Facility Setting.
Last Published 05.01.2024
Consistent with CMS guidelines, UnitedHealthcare Medicare Advantage will not allow separate reimbursement for Nonphysician services furnished to inpatients. All items and nonphysician services furnished to inpatients must be furnished directly by the hospital or billed through the hospital under arrangements. This provision applies to all hospitals, regardless of whether they are subject to PPS. R9046
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses services received while confined/incarcerated, or, if a juvenile, while detained in any facility.
Last Published 12.01.2023
Effective 12.01.2023 – This policy addresses services received while confined/incarcerated, or, if a juvenile, while detained in any facility.
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses services or costs associated with a non-covered service.
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses services or costs associated with a non-covered service.
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses specialized footwear, shoes, and foot orthotics.
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses specialized footwear, shoes, and foot orthotics.
Last Published 04.19.2024
These guidelines address the treatment of adult and pediatric sickle cell disease.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses Simponi Aria® (golimumab) injection for intravenous infusion for the treatment of ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, and polyarticular juvenile idiopathic arthritis. Applicable Procedure Code: J1602.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses Simponi Aria® (golimumab) injection for intravenous infusion for the treatment of ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, and polyarticular juvenile idiopathic arthritis. Applicable Procedure Code: J1602.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses Simponi Aria® (golimumab) injection for intravenous infusion for the treatment of ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, and polyarticular juvenile idiopathic arthritis. Applicable Procedure Code: J1602.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses crowns, onlays, and inlays. Applicable Procedure Codes: D2510, D2520, D2530, D2542, D2543, D2544, D2610, D2620, D2630, D2642, D2643, D2644, D2650, D2651, D2652, D2662, D2663, D2664, D2710, D2712, D2720, D2721, D2722, D2740, D2750, D2751, D2752, D2753, D2780, D2781, D2782, D2783, D2790, D2791, D2792, D2794, D2799.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses sinus procedures. Applicable Procedure Codes: 31240, 31253. 31254, 31255, 31256, 31257, 31259, 31267, 31276, 31287, 31288, 31295, 31296, 31297, 31298, 31299.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses a site of service differential that reduces practice expense payments for services provided in facility or ambulance settings.
Last Published 03.01.2024
Effective 03.01.2024 – This policy addresses skilled nursing facility (SNF) care.
Last Published 03.01.2024
Effective 03.01.2024 – This policy addresses skilled nursing facility (SNF) care.
Last Published 06.01.2024
This policy addresses cardiac rehabilitation (CR) exercise programs, supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) , outpatient rehabilitation therapy (physical and occupational therapy and speech-language pathology services), inpatient rehabilitation services, cognitive therapy, melodic intonation therapy, passive rehabilitation therapy for mandibular hypomobility, comprehensive computer-based motion analysis, and rehabilitation services for vision impairment. Applicable Procedure Codes: 92507, 92521, 92522, 92523, 92524, 92526, 92605, 92606, 92607, 92608, 92609, 92610, 93668, 93797, 93798, 94625, 94626, 96105, 96125, 97014, 97024, 97035, 97110, 97112, 97113, 97116, 97124, 97129, 97130, 97140, 97161, 97162, 97163, 97164, 97165, 97166, 97167, 97168, 97530, 97535, 97537, 97542, 97760, 97763.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses skin and soft tissue substitutes.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses skin and soft tissue substitutes. Applicable Procedure Codes: Q4101, Q4104, Q4106, Q4116, Q4121, Q4128, Q4132, Q4133, Q4151, Q4186
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses skin and soft tissue substitutes.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses skin and soft tissue substitutes.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses skin and soft tissue substitutes for the treatment of partial- and full-thickness diabetic lower extremity ulcers. Applicable Procedure Codes: Q4101, Q4106, Q4121, Q4154, Q4160, Q4186, Q4195, Q4196.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the intravenous use of Skyrizi® (risankizumab-rzaa) for the treatment of Crohn’s disease. Applicable Procedure Codes: C9399, J3490, J3590.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses the intravenous use of Skyrizi® (risankizumab-rzaa) injection for the treatment of Crohn’s disease (CD). Applicable Procedures Code: J2327.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses the intravenous use of Skyrizi® (risankizumab-rzaa) injection for the treatment of Crohn’s disease (CD). Applicable Procedures Code: J2327.
Last Published 06.01.2024
This policy addresses diagnosis and treatment of obstructive sleep apnea (OSA). Applicable Procedure Codes: 21685, 41512, 41530, 41599, 42145, 64569, 64570, 64582, 64583, 64584, 95800, 95801, 95806, G0398, G0399, G0400.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses home sleep apnea testing, attended full-channel nocturnal polysomnography performed in a healthcare facility or laboratory setting, daytime sleep studies, and attended PAP titration. Applicable Procedure Codes: 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses home sleep apnea testing, attended full-channel nocturnal polysomnography performed in a healthcare facility or laboratory setting, daytime sleep studies, and attended PAP titration. Applicable Procedure Codes: 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses home sleep apnea testing, attended full-channel nocturnal polysomnography performed in a healthcare facility or laboratory setting, daytime sleep studies, and attended PAP titration. Applicable Procedure Codes: 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses home sleep apnea testing, attended full-channel nocturnal polysomnography performed in a healthcare facility or laboratory setting, daytime sleep studies, and attended PAP titration. Applicable Procedure Codes: 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses home sleep apnea testing, attended full-channel polysomnography performed in a healthcare facility or laboratory setting, daytime sleep studies, attended PAP titration and attended repeat testing. Applicable Procedure Codes: 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses home sleep apnea testing, attended full-channel nocturnal polysomnography performed in a healthcare facility or laboratory setting, daytime sleep studies, and attended PAP titration, and attended repeat testing. Applicable Procedure Codes: 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses home sleep apnea testing, attended full-channel nocturnal polysomnography performed in a healthcare facility or laboratory setting, daytime sleep studies, and attended PAP titration. Applicable Procedure Codes: 95782, 95783, 95800, 95801, 95803, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400.
Last Published 06.01.2024
This policy addresses sleep testing for obstructive sleep apnea (OSA). Applicable Procedure Codes: 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400.
Last Published 01.24.2024
Effective as of October 1, 2020, unless prohibited by federal or state law, this Protocol applies to health care physicians, health care professionals, facilities and ancillary providers who provide services to a UnitedHealthcare member, capture Social Determinants of Health (SDoH), as defined below, and utilize ICD-10 diagnostic code(s) (or successor diagnostic codes) in the medical record.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of sodium hyaluronate products. Applicable Procedure Codes: 20605, 20606, 20610, 20611, J3490, J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, J7331, J7332.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses intra-articular injections of sodium hyaluronate. Applicable Procedure Codes: 20605, 20606, 20610, 20611, J3490, J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, J7331, J7332.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses intra-articular injections of sodium hyaluronate. Applicable Procedure Codes: 20605, 20606, 20610, 20611, J3490, J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, J7331, J7332.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses intra-articular injections of sodium hyaluronate. Applicable Procedure Codes: 20605, 20606, 20610, 20611, J3490, J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, J7331, J7332.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses intra-articular injections of sodium hyaluronate. Applicable Procedure Codes: 20605, 20606, 20610, 20611, J3490, J7318, J7320, J7321, J7322, J7323, J7324, J7325, J7326, J7327, J7328, J7329, J7331, J7332.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses intra-articular injections of sodium hyaluronate. Applicable Procedure Codes: 20605, 20606, 20610, 20611, J7324, J7325, J7326, J7327, J7328, J7329, J7331, J7332.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of somatostatin analogs, including Sandostatin® (octreotide acetate), Sandostatin® LAR (octreotide acetate LAR), Signifor® (pasireotide diaspartate), Signifor® LAR (pasireotide), and Somatuline® Depot (lanreotide). Applicable Procedure Codes: J1930, J1932, J2353, J2354, J2502.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of somatostatin analogs, including Sandostatin® (octreotide acetate), Sandostatin® LAR (octreotide acetate LAR), Signifor® (pasireotide diaspartate), Signifor® LAR (pasireotide), and Somatuline® Depot (lanreotide). Applicable Procedure Codes: J1930, J1932, J2353, J2354, J2502.
Last Published 07.01.2023
Effective Date: 08.01.2023 – This policy addresses the use of somatostatin analogs, including Sandostatin® (octreotide acetate), Sandostatin® LAR (octreotide acetate LAR), Signifor® (pasireotide diaspartate), Signifor® LAR (pasireotide), and Somatuline® Depot (lanreotide). Applicable Procedure Codes: J1930, J1932, J2353, J2354, J2502.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of somatostatin analogs, including Sandostatin® (octreotide acetate), Sandostatin® LAR (octreotide acetate LAR), Signifor® (pasireotide diaspartate), Signifor® LAR (pasireotide), and Somatuline® Depot (lanreotide). Applicable Procedure Codes: J1930, J1932, J2353, J2354, J2502.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of somatostatin analogs, including Sandostatin® (octreotide acetate), Sandostatin® LAR (octreotide acetate LAR), Signifor® (pasireotide diaspartate), Signifor® LAR (pasireotide), and Somatuline® Depot (lanreotide), and Lanreotide Injection. Applicable Procedure Codes: J1930, J1932, J2353, J2354, J2502.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of somatostatin analogs, including Sandostatin® (octreotide acetate), Sandostatin® LAR (octreotide acetate LAR), Signifor® (pasireotide diaspartate), Signifor® LAR (pasireotide), and Somatuline® Depot (lanreotide). Applicable Procedure Codes: J1930, J1932, J2353, J2354, J2502.
Last Published 02.01.2024
Effective Date: 12.01.2023 – This policy addresses space maintainers. Applicable Procedure Codes: D1510, D1516, D1517, D1520, D1526, D1527, D1551, D1552, D1553, D1556, D1557, D1558, D1575, D1999.
Last Published 04.19.2024
This guideline defines the core components of a comprehensive, coordinated, and family-centered system of care for children and youth with special health care needs.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses speech generating devices. Applicable Procedure Codes: E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, E2599.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses speech generating devices. Applicable Procedure Codes: E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, E2599.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses speech generating devices. Applicable Procedure Codes: E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, E2599.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses speech generating devices. Applicable Procedure Codes: E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, E2599.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses speech generating devices. Applicable Procedure Codes: E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, E2599.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses speech generating devices. Applicable Procedure Codes: E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, E2599.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Spevigo® (spesolimab-sbzo) for the treatment of generalized pustular psoriasis (GPP). Applicable Procedure Code: J1747.
Last Published 06.01.2024
This policy addresses the implantation of spinal cord stimulators (SCS) for the relief of chronic intractable pain. Applicable Procedure Codes: 63650, 63655, 63685.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses spinal fusion enhancement products. Applicable Procedure Codes: 0814T, 20930, 20931, 20939, 22899.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses spinal fusion enhancement products. Applicable Procedure Codes: 0814T, 20930, 20931, 20939, 22899.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses spinal fusion and bone healing enhancement products. Applicable Procedure Codes: 0814T, 20930, 20931, 20939, 22899.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses spinal fusion enhancement products. Applicable Procedure Codes: 0814T, 20930, 20931, 20939, 22899.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses spinal fusion enhancement products. Applicable Procedure Codes: 0814T, 20930, 20931, 20939, 22899.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses spinal fusion enhancement products. Applicable Procedure Codes: 0814T, 20930, 20931, 20939, 22899.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses spinal fusion enhancement products. Applicable Procedure Codes: 0814T, 20930, 20931, 20939, 22899.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses spinal fusion enhancement products. Applicable Procedure Codes: 0814T, 20930, 20931, 20939, 22899.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses spinal fusion enhancement products. Applicable Procedure Codes: 0814T, 20930, 20931, 20939, 22899.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses spinal fusion enhancement products. Applicable Procedure Codes: 0814T, 20930, 20931, 20939, 22899.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses surgical treatment for spine pain.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses spinal fusion and decompression procedures, laminectomy, isolated facet fusion, dynamic stabilization systems, and total facet joint arthroplasty.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses spinal fusion and decompression procedures, laminectomy, isolated facet fusion, dynamic stabilization systems, and total facet joint arthroplasty.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses surgical treatment for spine pain.
Last Published 08.01.2023
Effective Date: 10.01.2023 – This policy addresses spinal fusion and decompression procedures, laminectomy, isolated facet fusion, dynamic stabilization systems, and total facet joint arthroplasty.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses spinal fusion and decompression procedures, laminectomy, isolated facet fusion, dynamic stabilization systems, and total facet joint arthroplasty.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses spinal fusion and decompression procedures, laminectomy, isolated facet fusion, dynamic stabilization systems, and total facet joint arthroplasty.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses spinal fusion and decompression procedures, laminectomy, isolated facet fusion, dynamic stabilization systems, and total facet joint arthroplasty.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses spinal fusion and decompression procedures, laminectomy, isolated facet fusion, dynamic stabilization systems, and total facet joint arthroplasty.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses spinal fusion and decompression procedures, laminectomy, isolated facet fusion, dynamic stabilization systems, and total facet joint arthroplasty.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses spinal fusion and decompression procedures, laminectomy, isolated facet fusion, dynamic stabilization systems, and total facet joint arthroplasty.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses spinal fusion and decompression procedures, laminectomy, isolated facet fusion, dynamic stabilization systems, and total facet joint arthroplasty.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Spinraza® (nusinersen) for the treatment of spinal muscular atrophy (SMA). Applicable Procedure Code: J2326.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses the use of Spinraza® (nusinersen) for the treatment of spinal muscular atrophy (SMA). Applicable Procedure Code: J2326.
Last Published 04.01.2024
The Surgical Package consists of the preoperative, surgical, and postoperative services. A Split Surgical Package occurs when the postoperative care is rendered by a physician other than the physician performing the surgical service.
Last Published 12.29.2023
The Surgical Package consists of the preoperative, surgical, and postoperative services. A Split Surgical Package occurs when the postoperative care is rendered by a physician other than the physician performing the surgical service. For example, one physician performs the surgical service only and turns the postoperative management over to a separate physician (not within the Same Group Practice).
Last Published 05.26.2023
The Surgical Package consists of the preoperative, surgical, and postoperative services. A Split Surgical Package occurs when the postoperative care is rendered by a physician other than the physician performing the surgical service.
Last Published 06.01.2024
This policy addresses the use of Spravato® (Esketamine) for the treatment of treatment-resistant depression (TRD) in adults. Applicable Procedure Codes: G2082, G2083.
Last Published 04.01.2024
This reimbursement policy addresses reimbursement for standby services and hospital mandated on call services.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Stelara® (ustekinumab) for the treatment of Crohn’s disease, plaque psoriasis, psoriatic arthritis, and ulcerative colitis. Applicable Procedure Codes: J3357, J3358.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of Stelara® (ustekinumab) for the treatment of Crohn’s disease, plaque psoriasis, psoriatic arthritis, and ulcerative colitis. Applicable Procedure Codes: J3357, J3358.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of Stelara® (ustekinumab) for the treatment of Crohn’s disease, plaque psoriasis, psoriatic arthritis, and ulcerative colitis. Applicable Procedure Codes: J3357, J3358.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses stereotactic radiation therapy, including stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Applicable Procedures Codes: 32701, 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77301, 77371, 77372, 77373, 77432, 77435, G0339, G0340.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses stereotactic radiation therapy, including stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Applicable Procedures Codes: 32701, 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77301, 77371, 77372, 77373, 77432, 77435, G0339, G0340.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses stereotactic radiation therapy, including stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Applicable Procedures Codes: 32701, 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77301, 77371, 77372, 77373, 77432, 77435, G0339, G0340.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses stereotactic radiation therapy, including stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Applicable Procedures Codes: 32701, 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77301, 77371, 77372, 77373, 77432, 77435, G0339, G0340.
Last Published 02.01.2024
Effective Date: 04.01.2024 – This policy addresses stereotactic radiation therapy, including stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Applicable Procedures Codes: 32701, 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77301, 77371, 77372, 77373, 77432, 77435, G0339, G0340.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses stereotactic radiation therapy, including stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Applicable Procedures Codes: 32701, 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77301, 77371, 77372, 77373, 77432, 77435, G0339, G0340.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses stereotactic radiation therapy, including stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Applicable Procedures Codes: 32701, 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77301, 77371, 77372, 77373, 77432, 77435, G0339, G0340.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses stereotactic radiation therapy, including stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Applicable Procedures Codes: 32701, 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77301, 77371, 77372, 77373, 77432, 77435, G0339, G0340.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses stereotactic radiation therapy, including stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). Applicable Procedures Codes: 32701, 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77301, 77371, 77372, 77373, 77432, 77435, G0339, G0340.
Last Published 11.23.2022
UnitedHealthcare reimburses providers for sterilization services when all requirements of 42 CFR §441.250 - 441.259 are met.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of compounded implantable drug pellets. Applicable Procedure Codes: 11981, 11982, 11983, J3490, J7999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of compounded implantable drug pellets. Applicable Procedure Codes: 11981, 11982, 11983, J3490, J7999.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of compounded implantable drug pellets. Applicable Procedure Codes: 11981, 11982, 11983, J3490, J7999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of compounded implantable drug pellets. Applicable Procedure Codes: 11981, 11982, 11983, J3490, J7999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of compounded implantable drug pellets. Applicable Procedure Codes: 11981, 11982, 11983, J3490, J7999.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses extended benefits for totally disabled members, including when a member changes carriers while confined in an inpatient facility.
Last Published 09.01.2023
This policy describes the reimbursement methodology for Healthcare Common Procedure Coding System (HCPCS) codes representing supplies, drugs and other items based on the Place of Service (POS) submitted and Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS) Relative Value File.
Last Published 11.23.2022
This policy describes the reimbursement methodology for Healthcare Common Procedure Coding System (HCPCS) codes representing supplies, drugs and other items based on the Place of Service (POS) submitted and Centers for Medicare and Medicaid Services (CMS).
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses surgery of the ankle. Applicable Procedure Codes: 27685, 27700, 27702, 27703, 27704, 29891, 29892, 29894, 29895, 29897, 29898, 29899.
Last Published 07.01.2023
Effective Date: 09.01.2023 – This policy addresses surgery of the ankle. Applicable Procedure Codes: 27685, 27700, 27702, 27703, 27704, 29891, 29892, 29894, 29895, 29897, 29898, 29899.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses surgery of the ankle. Applicable Procedure Codes: 27685, 27700, 27702, 27703, 27704, 29891, 29892, 29894, 29895, 29897, 29898, 29899.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses surgery of the ankle. Applicable Procedure Codes: 27685, 27700, 27702, 27703, 27704, 29891, 29892, 29894, 29895, 29897, 29898, 29899.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses surgery of the ankle. Applicable Procedure Codes: 27685, 27700, 27702, 27703, 27704, 29891, 29892, 29894, 29895, 29897, 29898, 29899.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses surgery of the ankle. Applicable Procedure Codes: 27685, 27700, 27702, 27703, 27704, 29891, 29892, 29894, 29895, 29897, 29898, 29899.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses surgery of the elbow. Applicable Procedure Codes: 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 29830, 29834, 29835, 29836, 29837, 29838.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses surgery of the elbow. Applicable Procedure Codes: 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 29830, 29834, 29835, 29836, 29837, 29838.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses surgery of the elbow. Applicable Procedure Codes: 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 29830, 29834, 29835, 29836, 29837, 29838.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses surgery of the elbow. Applicable Procedure Codes: 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 29830, 29834, 29835, 29836, 29837, 29838.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses surgery of the elbow. Applicable Procedure Codes: 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 29830, 29834, 29835, 29836, 29837, 29838.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses surgery of the elbow. Applicable Procedure Codes: 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 29830, 29834, 29835, 29836, 29837, 29838.
Last Published 12.01.2023
Effective Date: 11.01.2023 – This policy addresses surgery of the elbow. Applicable Procedure Codes: 24360, 24361, 24362, 24363, 24366, 24370, 24371, 29830, 29834, 29835, 29836, 29837, 29838.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses surgery of the elbow. Applicable Procedure Codes: 24360, 24361, 24362, 24363, 24366, 24370, 24371, 29830, 29834, 29837, 29838.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses surgery of the elbow. Applicable Procedure Codes: 24360, 24361, 24362, 24363, 24366, 24370, 24371, 29830, 29834, 29835, 29836, 29837, 29838.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses surgery of the foot. Applicable Procedure Codes: 28285, 28289, 28291, 28292, 28295, 28296, 28297, 28298, 28299, 29893.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses surgery of the foot. Applicable Procedure Codes: 28285, 28289, 28291, 28292, 28295, 28296, 28297, 28298, 28299, 29893.
Last Published 07.01.2023
Effective Date: 08.01.2023 – This policy addresses surgery of the foot. Applicable Procedure Codes: 28285, 28289, 28291, 28292, 28295, 28297, 28298, 28299, 28296, 28299, 29893.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses surgery of the foot. Applicable Procedure Codes: 28285, 28289, 28291, 28292, 28295, 28297, 28298, 28299, 28296, 28299, 29893.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses surgery of the foot. Applicable Procedure Codes: 28285, 28289, 28291, 28292, 28295, 28297, 28298, 28299, 28296, 28299, 29893.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses surgery of the foot. Applicable Procedure Codes: 28285, 28289, 28291, 28292, 28295, 28297, 28298, 28299, 28296, 28299, 29893.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses surgery of the foot. Applicable Procedure Codes: 28285, 28289, 28291, 28292, 28295, 28297, 28298, 28299, 28296, 28299, 29893.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses surgery of the hand or wrist. Applicable Procedure Codes: 25280, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 29840, 29843, 29844, 29845, 29846, 29847.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses surgery of the hand or wrist. Applicable Procedure Codes: 25280, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 29840, 29843, 29844, 29845, 29846, 29847.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses surgery of the hand or wrist. Applicable Procedure Codes: 25280, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 29840, 29843, 29844, 29845, 29846, 29847.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses surgery of the hand or wrist. Applicable Procedure Codes: 25280, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 29840, 29843, 29844, 29845, 29846, 29847.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses surgery of the hand or wrist. Applicable Procedure Codes: 25280, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 29840, 29843, 29844, 29845, 29846, 29847.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses surgery of the hand or wrist. Applicable Procedure Codes: 25280, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 26530, 26531, 26535, 26536, 29840, 29843, 29844, 29845, 29846, 29847.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses surgery of the hip and surgical treatment for femoroacetabular impingement (FAI) syndrome. Applicable Procedure Codes: 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27299, 29860, 29861, 29862, 29863, 29914, 29915, 29916, 29999, S2118.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses surgery of the hip and femoroacetabular impingement (FAI) syndrome. Applicable Procedure Codes: 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27299, 29860, 29861, 29862, 29863, 29914, 29915, 29916, 29999, S2118.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses surgery of the hip and femoroacetabular impingement (FAI) syndrome. Applicable Procedure Codes: 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27299, 29860, 29861, 29862, 29863, 29914, 29915, 29916, 29999, S2118.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses surgery of the hip and femoroacetabular impingement (FAI) syndrome. Applicable Procedure Codes: 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27299, 29860, 29861, 29862, 29863, 29914, 29915, 29916, 29999, S2118.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses surgery of the hip and femoroacetabular impingement (FAI) syndrome. Applicable Procedure Codes: 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27299, 29860, 29861, 29862, 29863, 29914, 29915, 29916, 29999, S2118.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses surgery of the hip and femoroacetabular impingement (FAI) syndrome. Applicable Procedure Codes: 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27299, 29860, 29861, 29862, 29863, 29914, 29915, 29916, 29999, S2118.
Last Published 12.01.2023
Effective Date: 11.01.2023 – This policy addresses surgery of the hip and femoroacetabular impingement (FAI) syndrome. Applicable Procedure Codes: 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27299, 29860, 29861, 29862, 29863, 29914, 29915, 29916, 29999, S2118.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses surgery of the hip and femoroacetabular impingement (FAI) syndrome. Applicable Procedure Codes: 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27299, 29860, 29861, 29862, 29863, 29914, 29915, 29916, 29999, S2118.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses surgery of the hip and femoroacetabular impingement (FAI) syndrome. Applicable Procedure Codes: 27120, 27125, 27130, 27132, 27134, 27137, 27138, 27299, 29860, 29861, 29862, 29863, 29914, 29915, 29916, 29999, S2118.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses surgery of the knee. Applicable Procedure Codes: 0737T, 27412, 27415, 27416, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 28446, 29866, 29867, 29868, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, G0428, J7330, S2112.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses surgery of the knee. Applicable Procedure Codes: 0737T, 27412, 27415, 27416, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 28466, 29866, 29867, 29868, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses surgery of the knee. Applicable Procedure Codes: 0737T, 27412, 27415, 27416, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 28446, 29866, 29867, 29868, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, G0428, J7330, S2112.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses surgery of the knee. Applicable Procedure Codes: 0737T, 27412, 27415, 27416, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 28446, 29866, 29867, 29868, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, G0428, J7330, S2112.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses autologous chondrocyte transplantation (ACT), osteochondral autograft and allograft transplantation, and microfracture repair of the knee. Applicable Procedure Codes: 0737T, 27412, 27415, 27516, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 28446, 29866, 29867, 29868, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, G0428, J7330, S2112.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses surgery of the knee. Applicable Procedure Codes: 0737T, 27412, 27415, 27416, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 28446, 29866, 29867, 29868, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, G0428, J7330, S2112.
Last Published 12.01.2023
Effective Date: 10.01.2023 – This policy addresses surgery of the knee. Applicable Procedure Codes: 0737T, 27412, 27415, 27416, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 28446, 29866, 29867, 29868, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, G0428, J7330, S2112.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses surgery of the knee. Applicable Procedure Codes: 0737T, 27412, 27415, 27416, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 28446, 29866, 29867, 29868, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, G0428, J7330, S2112.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses surgery of the knee. Applicable Procedure Codes: 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses surgery of the shoulder. Applicable Procedure Codes: 23470, 23472, 23473, 23474, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828, 29999.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses surgery of the shoulder. Applicable Procedure Codes: 23470, 23472, 23473, 23474, 29805, 29806, 29807, 29819, 29820, 29822, 29823, 29824, 29825, 29826, 29827, 29828, 29999.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses surgery of the shoulder. Applicable Procedure Codes: 23470, 23472, 23473, 23474, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828, 29999.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses surgery of the shoulder. Applicable Procedure Codes: 23470, 23472, 23473, 23474, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828, 29999.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses surgery of the shoulder. Applicable Procedure Codes: 23470, 23472, 23473, 23474, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828, 29999.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses surgery of the shoulder. Applicable Procedure Codes: 23470, 23472, 23473, 23474, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828, 29999.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses surgery of the shoulder. Applicable Procedure Codes: 23470, 23472, 23473, 23474, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828, 29999.
Last Published 12.01.2023
Effective Date: 11.01.2023 – This policy addresses surgery of the shoulder. Applicable Procedure Codes: 23470, 23472, 23473, 23474, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses surgery of the shoulder. Applicable Procedure Codes: 23470, 23472, 23473, 23474, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses surgery of the shoulder. Applicable Procedure Codes: 23470, 23472, 23473, 23474, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses varicose vein ablative and stripping procedures, ligation procedures, ambulatory phlebectomy, sclerotherapy, and endovascular embolization. Applicable Procedure Codes: 0744T, 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37500, 37700, 37718, 37722, 37735, 37765, 37766, 37780, 37785, 37799.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses varicose vein ablative and stripping procedures and ligation procedures. Applicable Procedure Codes: 36465, 36466, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37500, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 37799.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses varicose vein ablative and stripping procedures and ligation procedures. Applicable Procedure Codes: 0744T, 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37500, 37700, 37718, 37722, 37735, 37765, 37766, 37780, 37785, 37799.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses varicose vein ablative and stripping procedures and ligation procedures. Applicable Procedure Codes: 0744T, 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37500, 37700, 37718, 37722, 37735, 37765, 37766, 37780, 37785, 37799.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses varicose vein ablative and stripping procedures and ligation procedures. Applicable Procedure Codes: 0744T, 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37500, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 37799.
Last Published 10.01.2023
Effective Date: 12.01.2023 – This policy addresses varicose vein ablative and stripping procedures and ligation procedures. Applicable Procedure Codes: 0744T, 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37500, 37700, 37718, 37722, 37735, 37765, 37766, 37780, 37785, 37799.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses varicose vein ablative and stripping procedures and ligation procedures. Applicable Procedure Codes: 0744T, 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37500, 37700, 37718, 37722, 37735, 37765, 37766, 37780, 37785, 37799.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses varicose vein ablative and stripping procedures, ligation procedures, ambulatory phlebectomy, and other procedures for varicose veins and venous insufficiency. Applicable Procedure Codes: 0744T, 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37500, 37700, 37718, 37722, 37735, 37765, 37766, 37780, 37785, 37799.
Last Published 06.01.2023
Effective Date: 07.01.2023 – This policy addresses varicose vein ablative and stripping procedures, ligation procedures, and ambulatory phlebectomy. Applicable Procedure Codes: 0744T, 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37500, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 37799.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses varicose vein ablative and stripping procedures, ligation procedures, and ambulatory phlebectomy. Applicable Procedure Codes: 0744T, 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37500, 37700, 37718, 37722, 37735, 37765, 37766, 37780, 37785, 37799.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses varicose vein ablative and stripping procedures and ligation procedures. Applicable Procedure Codes: 0744T, 36465, 36466, 36468, 36470, 36471, 36473, 36474, 36475, 36476, 36478, 36479, 36482, 36483, 37500, 37700, 37718, 37722, 37735, 37765, 37766, 37780, 37785, 37799.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses apicoectomy, surgical exposure of root surface(s) (without apicoectomy or repair of root resorption), retrograde filling, root amputation, intentional reimplantation, hemisection, bone graft in conjunction with periradicular surgery, biologic materials to aid in soft and osseous tissue regeneration in conjunction with periradicular surgery, and guided tissue regeneration resorbable barrier in conjunction with periradicular surgery. Applicable Procedure Codes: D3410, D3421, D3425, D3426, D3430, D3450, D3460, D3470, D3471, D3472, D3473, D3501, D3502, D3503, D3910, D3920, D3950, D3999.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses surgical extraction of erupted teeth and surgical removal of residual tooth roots. Applicable Procedure Codes: D7210, D7250, D7922.
Last Published 02.01.2024
Effective Date: 12.01.2023 – This policy addresses surgical extraction of soft tissue impacted teeth, surgical extraction of partially bony impacted teeth, surgical extraction of completely bony impacted teeth, and coronectomy. Applicable Procedure Codes: D7220, D7230, D7240, D7241, D7251, D7922.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses tissue graft procedures and biologic materials to aid in soft and osseous tissue regeneration. Applicable Procedure Codes: D4268, D4270, D4273, D4275, D4276, D4277, D4278, D4283, D4285, D4999.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses gingivectomy/gingivoplasty, anatomical crown exposure, flap procedures, clinical crown lengthening-hard tissue, osseous surgery, mesial/distal wedge, and resective periodontal surgical procedures. Applicable Procedure Codes: D4210, D4211, D4212, D4230, D4231, D4240, D4241, D4245, D4249, D4260, D4261, D4274, D4999.
Last Published 06.01.2024
This policy addresses multiple surgical procedures that utilize InterQual® coverage guidelines when no Medicare coverage criteria exists.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses surgical procedures for the treatment or prevention of lymphedema. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 38999, 49906.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses surgical procedures for the treatment or prevention of lymphedema. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 38999, 49906.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses surgical procedures for the treatment or prevention of lymphedema. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 38999, 49906.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses surgical procedures for the treatment or prevention of lymphedema. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 38999, 49906.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses surgical procedures for the treatment or prevention of lymphedema. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 38999, 49906.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses surgical procedures for the treatment or prevention of lymphedema. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 38999, 49906.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses surgical procedures for the treatment or prevention of lymphedema. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 38999, 49906.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses surgical procedures for the treatment or prevention of lymphedema. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 38999, 49906.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses surgical procedures for the treatment or prevention of lymphedema. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 38999, 49906.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses surgical procedures for the treatment or prevention of lymphedema. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 38999, 4990
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses surgical procedures for the treatment or prevention of lymphedema. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 38999, 49906.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses surgical procedures for the treatment or prevention of lymphedema. Applicable Procedure Codes: 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15847, 15876, 15877, 15878, 15879, 38999, 49906.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses the use of a sympathetic blockade using a local anesthetic. Applicable Procedure Codes: 64510, 64517, 64520, 64530.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses the use of a sympathetic blockade using a local anesthetic. Applicable Procedure Codes: 64510, 64517, 64520, 64530.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses the use of a sympathetic blockade using a local anesthetic. Applicable Procedure Codes: 64510, 64517, 64520, 64530.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Synagis® (palivizumab) to prevent serious respiratory syncytial virus disease (RSV) in high risk infants and young children. Applicable Procedure Code: 90378.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Synagis® (palivizumab) to prevent serious respiratory syncytial virus disease (RSV) in high risk infants and young children. Applicable Procedure Code: 90378.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Synagis® (palivizumab) to prevent serious respiratory syncytial virus disease (RSV) in high risk infants and young children. Applicable Procedure Code: 90378.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Synagis® (palivizumab) to prevent serious respiratory syncytial virus disease (RSV) in high risk infants and young children. Applicable Procedure Code: 90378.
Last Published 04.01.2024
All codes published on the National Physician Fee Schedule (NPFS) by the Centers for Medicare and Medicaid Services (CMS) are assigned a status code. The status code indicates whether the code is separately payable if the service is covered. R0107 Flag: TST2D, TSTDN
Last Published 01.02.2024
This reimbursement policy applies to services reported using the 1500 Health Insurance Claim Form (a/k/a CMS-1500) or its electronic equivalent or its successor form. This policy applies to all products and all network and non-network physicians and other qualified health care professionals, including, but not limited to, non-network authorized and percent of charge contract physicians and other qualified health care professionals.
Last Published 01.11.2024
All codes published on the National Physician Fee Schedule (NPFS) by the Centers for Medicare and Medicaid Services (CMS) are assigned a status code.
Last Published 03.19.2024
This policy describes reimbursement for Telemedicine and Telehealth services, which are services where the physician or other healthcare professional and the patient are not at the same site. R9039A
Last Published 05.01.2024
The policy describes how UnitedHealthcare reimburses UB-04 claims for telehealth originating site code Q3014 and the appropriate use of type of bill (TOB) codes. R5031
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Tepezza® (teprotumumab-trbw) for the treatment of thyroid eye disease. Applicable Procedure Code: J3241.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of Tepezza® (teprotumumab-trbw) for the treatment of thyroid eye disease. Applicable Procedure Code: J3241.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of Tepezza® (teprotumumab-trbw) for the treatment of thyroid eye disease. Applicable Procedure Code: J3241.
Last Published 09.01.2023
Effective Date: 10.01.2023 – This policy addresses the use of Tepezza® (teprotumumab-trbw) for the treatment of thyroid eye disease. Applicable Procedure Code: J3241.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Tepezza® (teprotumumab-trbw) for the treatment of thyroid eye disease. Applicable Procedure Code: J3241.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Tepezza® (teprotumumab-trbw) for the treatment of thyroid eye disease. Applicable Procedure Code: J3241.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Tepezza® (teprotumumab-trbw) for the treatment of thyroid eye disease. Applicable Procedure Code: J3241.
Last Published 06.01.2024
This policy addresses injectable testosterone pellets (Testopel®). Applicable Procedure Codes: 11980, J3490.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of injectable testosterone and testosterone pellets for replacement therapy in conditions associated with a deficiency or absence of endogenous testosterone. Applicable Procedure Codes: 11980, J1071, J3121, J3145, S0189.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Tezspire® (tezepelumab) for the treatment of severe asthma. Applicable Procedure Code: J2356.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Tezspire® (tezepelumab) for the treatment of severe asthma. Applicable Procedure Code: J2356.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of Tezspire® (tezepelumab) for the treatment of severe asthma. Applicable Procedure Codes: C9399, J3490, J3590.
Last Published 06.01.2024
This policy addresses Tier 2 molecular pathology procedures, which are procedures not identified by Tier 1 molecular pathology procedures or other CPT codes. Applicable Procedure Codes: 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408.
Last Published 04.22.2024
Within the code description, Current Procedural Terminology (CPT®) book parentheticals and coding guidance by the American Medical Association (AMA) or Centers for Medicare and Medicaid Services (CMS) in other publications, certain CPT and Healthcare Common Procedure Coding System (HCPCS) Level II codes specify a time parameter for which the code should be reported (e.g., weekly, monthly). This policy describes reimbursement for these Time Span Codes. R0102A Flag: TSC
Last Published 04.22.2024
UnitedHealthcare Medicare Advantage will reimburse a CPT or HCPCS Level II code that specifies a time period for which it should be reported (e.g., weekly, monthly), once during that time period. R9040
Last Published 04.19.2024
This guideline addresses the assessment of cigarette smoking and nicotine dependence, as well as behavioral, pharmacological, and supportive interventions that can be used in both inpatient and outpatient settings.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses topical application of fluoride excluding varnish, topical application of fluoride varnish, interim caries arresting medicament (silver diamine fluoride) application, and caries preventive medicament application. Applicable Procedure Codes: D1206, D1208, D1354, D1355.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses cervical and lumbar artificial total disc replacement. Applicable Procedure Codes: 0098T, 0165T, 22856, 22857, 22858, 22860, 22861, 22862, 22899.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses cervical and lumbar artificial total disc replacement. Applicable Procedure Codes: 0098T, 0165T, 22856, 22857, 22858, 22860, 22861, 22862, 22899.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses cervical and lumbar artificial total disc replacement. Applicable Procedure Codes: 0098T, 0165T, 22856, 22857, 22858, 22860, 22861, 22862, 22899.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses cervical and lumbar artificial total disc replacement. Applicable Procedure Codes: 0098T, 0165T, 22856, 22857, 22858, 22860, 22861, 22862, 22899.
Last Published 05.01.2023
Effective Date: 06.01.2023 – This policy addresses cervical and lumbar artificial total disc replacement. Applicable Procedure Codes: 0098T, 0165T, 22856, 22857, 22858, 22860, 22861, 22862, 22899.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses cervical and lumbar artificial total disc replacement. Applicable Procedure Codes: 0098T, 0165T, 22856, 22857, 22858, 22860, 22861, 22862, 22899.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses cervical and lumbar artificial total disc replacement. Applicable Procedure Codes: 0098T, 0165T, 22856, 22857, 22858, 22860, 22861, 22862, 22899.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses cervical and lumbar artificial total disc replacement. Applicable Procedure Codes: 0098T, 0165T, 22856, 22857, 22858, 22860, 22861, 22862, 22899.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses cervical and lumbar artificial total disc replacement. Applicable Procedure Codes: 0095T, 0098T, 0163T, 0164T, 0165T, 22856, 22857, 22858, 22861, 22862, 22864, 22865, 22899.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses cervical and lumbar artificial total disc replacement. Applicable Procedure Codes: 0098T, 0165T, 22856, 22857, 22858, 22861, 22862, 22899.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the SynCardia™ temporary Total Artificial Heart and ventricular assist devices/mechanical circulatory support devices. Applicable Procedure Codes: 33927, 33928, 33975, 33976, 33979, 33981, 33982, 33983, 33995, 33997.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the SynCardia™ temporary total artificial heart. Applicable Procedure Codes: 33927, 33928, 33975, 33976, 33979, 33981, 33982, 33983, 33995, 33997.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the SynCardia™ temporary Total Artificial Heart. Applicable Procedure Codes: 33927, 33928, 33975, 33976, 33979, 33981, 33982, 33983, 33995, 33997.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the SynCardia™ temporary total artificial heart. Applicable Procedure Codes: 33927, 33928, 33975, 33976, 33979, 33981, 33982, 33983, 33995, 33997.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses total artificial heart and ventricular assist devices. Applicable Procedure Codes: 33927, 33928, 33975, 33976, 33979, 33981, 33982, 33983, 33995, 33997.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the SynCardia™ temporary Total Artificial Heart. Applicable Procedure Codes: 33927, 33928, 33975, 33976, 33979, 33981, 33982, 33983, 33995, 33997.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the SynCardia™ temporary Total Artificial Heart. Applicable Procedure Codes: 33927, 33928, 33975, 33976, 33979, 33981, 33982, 33983, 33995, 33997.
Last Published 12.01.2023
Effective Date: 11.01.2023 – This policy addresses the SynCardia™ temporary Total Artificial Heart. Applicable Procedure Codes: 33927, 33928, 33975, 33976, 33979, 33981, 33982, 33983, 33995, 33997.
Last Published 11.01.2023
Effective Date: 10.01.2023 – This policy addresses the SynCardia™ temporary Total Artificial Heart. Applicable Procedure Codes: 33927, 33928, 33975, 33976, 33979, 33981, 33982, 33983, 33995, 33997.
Last Published 11.08.2023
Effective Date: 10.01.2023 – This policy addresses the SynCardia™ temporary Total Artificial Heart. Applicable Procedure Codes: 33927, 33928, 33975, 33976, 33979, 33981, 33982, 33983, 33995, 33997.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses the SynCardia™ temporary Total Artificial Heart. Applicable Procedure Codes: 33927, 33928, 33975, 33976, 33979, 33981, 33982, 33983, 33995, 33997.
Last Published 09.20.2023
Effective Date: 09.01.2023 – This policy addresses transanal endoscopic microsurgery for the excision of small tumors localized to the rectum. Applicable Procedure Code: 0184T.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses transanal endoscopic microsurgery for the excision of small tumors localized to the rectum. Applicable Procedure Code: 0184T.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses transanal endoscopic microsurgery (TEMS) and transanal minimally invasive surgery (TAMIS). Applicable Procedure Code: 0184T.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses transanal endoscopic microsurgery (TEMS) and transanal minimally invasive surgery (TAMIS). Applicable Procedure Code: 0184T.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses transanal endoscopic microsurgery (TEMS) and transanal minimally invasive surgery (TAMIS). Applicable Procedure Code: 0184T.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses transanal endoscopic microsurgery for the excision of small tumors localized to the rectum. Applicable Procedure Code: 0184T.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses transanal endoscopic microsurgery for the excision of small tumors localized to the rectum. Applicable Procedure Code: 0184T.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses transanal endoscopic microsurgery for the excision of small tumors localized to the rectum. Applicable Procedure Code: 0184T.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses transcatheter heart valve (aortic, mitral, pulmonary) procedures. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 0646T, 0805T, 0806T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33370, 33418, 33419, 33477, 33999, 93799.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses transcatheter heart valve (aortic, pulmonary, mitral) procedures. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 0646T, 0805T, 0806T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33370, 33418, 33419, 33477, 33999, 93799.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses transcatheter heart valve (aortic, pulmonary, mitral) procedures. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 0646T, 0805T, 0806T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33370, 33418, 33419, 33477, 33999, 93799.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses transcatheter heart valve (aortic, pulmonary, mitral) procedures. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 0646T, 0805T, 0806T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33370, 33418, 33419, 33477, 33999, 93799.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses transcatheter heart valve (aortic, pulmonary, mitral) procedures. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 0646T, 0805T, 0806T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33370, 33418, 33419, 33477, 33999, 93799.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses transcatheter heart valve (aortic, pulmonary, mitral) procedures. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 0646T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33370, 33418, 33419, 33477, 33999, 93799.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses transcatheter heart valve (aortic, pulmonary, mitral) procedures. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 0646T, 0805T, 0806T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33370, 33418, 33419, 33477, 33999, 93799.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses transcatheter heart valve (aortic, pulmonary, mitral) procedures. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 0646T, 0805T, 0806T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33370, 33418, 33419, 33477, 33999, 93799.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses transcatheter heart valve (aortic, pulmonary, mitral) procedures. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 0646T, 0805T, 0806T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33370, 33418, 33419, 33477, 33999, 93799.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses transcatheter heart valve (aortic, pulmonary, mitral) procedures. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 0646T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33418, 33419, 33477, 33999, 93799.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses transcatheter heart valve (aortic, pulmonary, mitral) procedures. Applicable Procedure Codes: 0345T, 0483T, 0484T, 0543T, 0544T, 0545T, 0569T, 0570T, 0646T, 0805T, 0806T, 33361, 33362, 33363, 33364, 33365, 33366, 33367, 33368, 33369, 33370, 33418, 33419, 33477, 33999, 93799.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses transcranial magnetic stimulation and navigated transcranial magnetic stimulation (nTMS). Applicable Procedure Codes: 0858T, 64999, 90867, 90868, 90869.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses transcranial magnetic stimulation and navigated transcranial magnetic stimulation (nTMS). Applicable Procedure Codes: 0858T, 64999, 90867, 90868, 90869.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses transcranial magnetic stimulation and navigated transcranial magnetic stimulation (nTMS). Applicable Procedure Codes: 0858T, 64999, 90867, 90868, 90869.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses transcranial magnetic stimulation and navigated transcranial magnetic stimulation (nTMS). Applicable Procedure Codes: 0858T, 64999, 90867, 90868, 90869.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses transcranial magnetic stimulation and navigated transcranial magnetic stimulation (nTMS). Applicable Procedure Codes: 0858T, 64999, 90867, 90868, 90869.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses transcranial magnetic stimulation and navigated transcranial magnetic stimulation (nTMS). Applicable Procedure Codes: 0858T, 64999, 90867, 90868, 90869.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses transcranial magnetic stimulation and navigated transcranial magnetic stimulation (nTMS). Applicable Procedure Codes: 0858T, 64999, 90867, 90868, 90869.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses transcranial magnetic stimulation and navigated transcranial magnetic stimulation (nTMS). Applicable Procedure Codes: 64999, 90867, 90868, 90869.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses transcranial magnetic stimulation and navigated transcranial magnetic stimulation (nTMS). Applicable Procedure Codes: 0858T, 64999, 90867, 90868, 90869.
Last Published 01.01.2024
This guideline outlines the general information, indications, contraindications, and special considerations for hematopoietic stem cell transplantation and provides links to relevant Ohio Administrative Code(s).
Last Published 12.29.2023
This guideline outlines the general information, indications, contraindications, and special considerations for hematopoietic stem cell transplantation.
Last Published 01.01.2024
This guideline outlines the general information, indications, contraindications, and special considerations for solid organ transplantation and provides links to relevant Ohio Administrative Code(s).
Last Published 12.29.2023
This guideline outlines general information, indications, universal and organ-specific contraindications, and special considerations for solid organ transplantation.
Last Published 10.01.2023
Effective 10.01.2023 – This policy addresses human organ and tissue transplants, donor-related services (including organ acquisition), pre-transplant testing and evaluation/examination, bone marrow and stem cell transplants, and transplant related costs and services.
Last Published 10.01.2023
Effective 10.01.2023 – This policy addresses human organ and tissue transplants, donor-related services (including organ acquisition), pre-transplant testing and evaluation/examination, bone marrow and stem cell transplants, and transplant related costs and services.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses transpupillary thermotherapy. Applicable Procedure Codes: 67299, 92499.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses transpupillary thermotherapy. Applicable Procedure Codes: 67299, 92499.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses transpupillary thermotherapy. Applicable Procedure Codes: 67299, 92499.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses transpupillary thermotherapy. Applicable Procedure Codes: 67299, 92499.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses transpupillary thermotherapy. Applicable Procedure Codes: 67299, 92499.
Last Published 04.02.2024
Effective Date: 04.01.2024 – This policy addresses transpupillary thermotherapy. Applicable Procedure Codes: 67299, 92499.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses transpupillary thermotherapy. Applicable Procedure Codes: 67299, 92499.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses transpupillary thermotherapy. Applicable Procedure Codes: 67299, 92499.
Last Published 05.01.2024
Effective 05.01.2024 – This policy addresses surgical and non-surgical treatments and related services for extreme obesity.
Last Published 05.01.2024
Effective 05.01.2024 – This policy addresses surgical and non-surgical treatments and related services for extreme obesity.
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses treatment for temporomandibular joint (TMJ) disorders.
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses treatment for temporomandibular joint (TMJ) disorders.
Last Published 05.01.2024
Effective Date: 03.01.2024 – This policy addresses treatment of temporomandibular joint (TMJ) disorders. Applicable Procedure Codes: 20552, 20553, 20605, 20606, 21010, 21050, 21060, 21070, 21085, 21089, 21110, 21240, 21242, 21243, 21247, 21299, 21499, 29800, 29804, 90901, 97039, 97139, E0746, E1399, E1700, E1701, E1702.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses treatment of temporomandibular joint (TMJ) disorders. Applicable Procedure Codes: 20552, 20553, 20605, 20606, 21010, 21050, 21060, 21070, 21085, 21089, 21110, 21240, 21242, 21243, 21247, 21299, 21499, 29800, 29804, 90901, 97039, 97139, E0746, E1399, E1700, E1701, E1702.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses treatment of temporomandibular joint (TMJ) disorders. Applicable Procedure Codes: 20552, 20553, 20605, 20606, 21010, 21050, 21060, 21070, 21085, 21089, 21110, 21240, 21242, 21243, 21247, 21299, 21499, 29800, 29804, 90901, 97039, 97139, E0746, E1399, E1700, E1701, E1702.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses treatment of temporomandibular joint (TMJ) disorders. Applicable Procedure Codes: 20552, 20553, 20605, 20606, 21010, 21050, 21060, 21070, 21085, 21089, 21110, 21240, 21242, 21243, 21247, 21299, 21499, 29800, 29804, 97039, 97139, E1399, E1700, E1701, E1702.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses treatment of temporomandibular joint (TMJ) disorders. Applicable Procedure Codes: 20552, 20553, 20605, 20606, 21010, 21050, 21060, 21070, 21085, 21089, 21110, 21240, 21242, 21243, 21247, 21299, 21499, 29800, 29804, 90901, 97039, 97139, E0746, E1399, E1700, E1701, E1702.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses treatment of temporomandibular joint (TMJ) disorders. Applicable Procedure Codes: 20552, 20553, 20605, 20606, 21010, 21050, 21060, 21070, 21085, 21089, 21110, 21198, 21209, 21240, 21242, 21243, 21247, 21299, 21499, 29800, 29804, 90901, 97039, 97139, E0746, E1399, E1700, E1701, E1702.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses treatment of temporomandibular joint (TMJ) disorders. Applicable Procedure Codes: 20552, 20553, 20605, 20606, 21010, 21050, 21060, 21070, 21085, 21089, 21110, 21240, 21242, 21243, 21247, 21299, 21499, 29800, 29804, 90901, 97039, 97139, E0746, E1399, E1700, E1701, E1702.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses treatment of temporomandibular joint (TMJ) disorders. Applicable Procedure Codes: 20552, 20553, 20605, 20606, 21010, 21050, 21060, 21070, 21085, 21089, 21110, 21240, 21242, 21243, 21247, 21299, 21499, 29800, 29804, 90901, 97039, 97139, E0746, E1399, E1700, E1701, E1702.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses treatment of temporomandibular joint (TMJ) disorders. Applicable Procedure Codes: 20552, 20553, 20605, 20606, 21010, 21050, 21060, 21070, 21085, 21089, 21110, 21240, 21242, 21243, 21247, 21299, 21499, 29800, 29804, 90901, 97039, 97139, E0746, E1399, E1700, E1701, and E1702.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses treatment of temporomandibular joint (TMJ) disorders. Applicable Procedure Codes: 20552, 20553, 20605, 20606, 21010, 21050, 21060, 21070, 21085, 21089, 21110, 21198, 21209, 21240, 21242, 21243, 21247, 21299, 21499, 29800, 29804, 90901, 97039, 97139, E0746, E1399, E1700, E1701, E1702.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses treatment of temporomandibular joint (TMJ) disorders. Applicable Procedure Codes: 20552, 20553, 20605, 20606, 21010, 21050, 21060, 21070, 21085, 21089, 21110, 21198, 21209, 21240, 21242, 21243, 21247, 21299, 21499, 29800, 29804, 90901, 97039, 97139, E0746, E1399, E1700, E1701, E1702.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Tysabri® (natalizumab) for the treatment of relapsing forms of multiple sclerosis and Crohn's disease. Applicable Procedure Code: J2323.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Tysabri® (natalizumab) for the treatment of relapsing forms of multiple sclerosis and Crohn's disease. Applicable Procedure Code: J2323.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Tysabri® (natalizumab) for the treatment of relapsing forms of multiple sclerosis and Crohn's disease. Applicable Procedure Code: J2323.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Tzield® (teplizumab-mzwv) to delay the onset of stage 3 type 1 diabetes. Applicable Procedure Code: J9381.
Last Published 09.01.2023
Effective Date: 10.01.2023 – This policy addresses the use of Tzield® (teplizumab-mzwv) to delay the onset of stage 3 type 1 diabetes. Applicable Procedure Codes: C9149, J3490, J3590.
Last Published 10.01.2023
Effective Date: 10.01.2023 – This policy addresses the use of Tzield® (teplizumab-mzwv) to delay the onset of stage 3 type 1 diabetes. Applicable Procedure Codes: C9149, J3490, J3590.
Last Published 11.01.2023
Effective Date: 09.01.2023 – This policy addresses the use of Tzield® (teplizumab-mzwv) to delay the onset of stage 3 type 1 diabetes. Applicable Procedure Code: J9381.
Last Published 09.01.2023
Effective Date: 09.01.2023 – This policy addresses the use of Tzield® (teplizumab-mzwv) to delay the onset of stage 3 type 1 diabetes. Applicable Procedure Codes: C9399, J3490, J3590.
Last Published 06.01.2023
Effective Date: 07.01.2023 – This policy addresses the use of Tzield™ (teplizumab-mzwv) to delay the onset of stage 3 type 1 diabetes. Applicable Procedure Codes: C9149, J3490, J3590.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses collection and storage of umbilical cord blood. Applicable Procedure Codes: 38205, 38206, 38207, 88240, S2140.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses collection and storage of umbilical cord blood. Applicable Procedure Codes: 38205, 38206, 38207, 88240, S2140.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses collection and storage of umbilical cord blood. Applicable Procedure Codes: 38205, 38206, 38207, 88240, S2140.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses collection and storage of umbilical cord blood. Applicable Procedure Codes: 38205, 38206, 38207, 88240, S2140.
Last Published 08.01.2023
Effective Date: 08.01.2023 – This policy addresses collection and storage of umbilical cord blood. Applicable Procedure Codes: 38205, 38206, 38207, 88240, S2140.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses unicondylar spacer devices for treating knee joint pain or disability from any cause. Applicable Procedure Code: 27599.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses unicondylar spacer devices for treating knee joint pain or disability from any cause. Applicable Procedure Code: 27599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses unicondylar spacer devices for treating knee joint pain or disability from any cause. Applicable Procedure Code: 27599.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses unicondylar spacer devices for treating knee joint pain or disability from any cause. Applicable Procedure Code: 27599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses unicondylar spacer devices for treating knee joint pain or disability from any cause. Applicable Procedure Code: 27599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses unicondylar spacer devices for treating knee joint pain or disability from any cause. Applicable Procedure Code: 27599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses unicondylar spacer devices for treating knee joint pain or disability from any cause. Applicable Procedure Code: 27599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses unicondylar spacer devices for treating knee joint pain or disability from any cause. Applicable Procedure Code: 27599.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses unicondylar spacer devices for treating knee joint pain or disability from any cause. Applicable Procedure Code: 27599.
Last Published 02.06.2024
These Medical Condition Assessment Incentive Program Terms and Conditions (“Terms and Conditions”) govern the UnitedHealthcare Medical Condition Assessment Incentive Program (“MCAIP”).
Last Published 11.22.2023
These Medicare Advantage Intermediate Physician Incentive Program Terms and Conditions (“Terms and Conditions”) govern the UnitedHealthcare Medicare Advantage Intermediate Physician Incentive (“MA-IPi”) Program.
Last Published 11.20.2023
These Medicare Advantage Primary Care Physician Incentive Program Terms and Conditions (“Terms and Conditions”) govern the UnitedHealthcare Medicare Advantage Primary Care Physician Incentive (“MA-PCPi”) Program.
Last Published 02.16.2024
An unlisted code may be submitted for a procedure or service that does not have a valid, more descriptive CPT or HCPCS code assigned.
Last Published 01.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of Ketalar® (ketamine) for anesthesia purposes and Spravato® (esketamine) for the treatment of treatment-resistant depression (TRD) and major depressive disorder (MDD). Applicable Procedure Codes: J3490, S0013.
Last Published 01.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of Ketalar® (ketamine) for anesthesia purposes and Spravato® (esketamine) for the treatment of treatment-resistant depression (TRD) and major depressive disorder (MDD). Applicable Procedure Codes: J3490, S0013.
Last Published 01.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of vascular endothelial growth factor (VEGF) inhibitors. Applicable Procedure Codes: J0178, J0179, J2777, J2778, J2779, J9035, Q5124, Q5128.
Last Published 01.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of intravenous iron replacement therapy with Feraheme® (ferumoxytol), Injectafer® (ferric carboxymaltose), and Monoferric® (ferric derisomaltose) for the treatment of iron deficiency anemia (IDA) with and without chronic kidney disease (CKD). Applicable Procedure Codes: J1437, J1439, Q0138, Q0139.
Last Published 01.01.2024
ffective Date: 02.01.2024 – This policy addresses the use of Cimzia® (certolizumab pegol) the treatment of Crohn’s disease, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, non-radiographic axial spondyloarthritis, and plaque psoriasis. Applicable Procedures Codes: 96372, 96401, J0717.
Last Published 01.01.2024
Effective Date: 02.01.2024 – This policy addresses the use of Actemra® (tocilizumab) injection for intravenous infusion for the treatment of polyarticular juvenile idiopathic arthritis, rheumatoid arthritis, systemic juvenile idiopathic arthritis, cytokine release syndrome, acute graft-versus-host disease, and immune checkpoint inhibitor-related toxicities. Applicable Procedure Code: J3262.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses Uplizna® (inebilizumab-cdon) for the treatment of neuromyelitis optica spectrum disorder (NMOSD). Applicable Procedures Code: J1823.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses Uplizna® (inebilizumab-cdon) for the treatment of neuromyelitis optica spectrum disorder (NMOSD). Applicable Procedure Code: J1823.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses Uplizna® (inebilizumab-cdon) for the treatment of neuromyelitis optica spectrum disorder (NMOSD). Applicable Procedures Code: J1823.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses Uplizna® (inebilizumab-cdon) for the treatment of neuromyelitis optica spectrum disorder (NMOSD). Applicable Procedures Code: J1823.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses upper extremity myoelectric prosthetic devices.
Last Published 05.01.2023
Effective Date: 07.01.2023 – This policy addresses upper extremity myoelectric prosthetic devices.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses upper extremity myoelectric prosthetic devices. Applicable Procedure Codes: L6026, L6611, L6621, L6629, L6632, L6677, L6680, L6682, L6686, L6687, L6688, L6694, L6695, L6696, L6697, L6698, L6715, L6880, L6881, L6882, L6883, L6884, L6890, L6925, L6935, L6945, L6955, L6975, L7007, L7008, L7009, L7045, L7180, L7181, L7190, L7191, L7259, L7360, L7364, L7366, L7367, L7368, L7400, L7401, L7403, L7404, L8465.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses upper extremity myoelectric prosthetic devices. Applicable Procedure Codes: L6026, L6611, L6621, L6629, L6632, L6677, L6680, L6682, L6686, L6687, L6688, L6694, L6695, L6696, L6697, L6698, L6715, L6880, L6881, L6882, L6883, L6884, L6890, L6925, L6935, L6945, L6955, L6975, L7007, L7008, L7009, L7045, L7180, L7181, L7190, L7191, L7259, L7360, L7364, L7366, L7367, L7368, L7400, L7401, L7403, L7404, L8465.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses upper extremity prosthetic devices. Applicable Procedure Codes: L6026, L6611, L6621, L6629, L6632, L6677, L6680, L6682, L6686, L6687, L6688, L6694, L6695, L6696, L6697, L6698, L6715, L6880, L6881, L6882, L6883, L6884, L6890, L6925, L6935, L6945, L6955, L6975, L7007, L7008, L7009, L7045, L7180, L7181, L7190, L7191, L7259, L7360, L7364, L7366, L7367, L7368, L7400, L7401, L7403, L7404, L8465.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses upper extremity prosthetic devices.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses upper extremity prosthetic devices. Applicable Procedure Codes: L6026, L6611, L6621, L6629, L6632, L6677, L6680, L6682, L6686, L6687, L6688, L6694, L6695, L6696, L6697, L6698, L6715, L6880, L6881, L6882, L6883, L6884, L6890, L6925, L6935, L6945, L6955, L6975, L7007, L7008, L7009, L7045, L7180, L7181, L7190, L7191, L7259, L7360, L7364, L7366, L7367, L7368, L7400, L7401, L7403, L7404, L8465.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses upper extremity myoelectric prosthetic devices.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses upper extremity myoelectric prosthetic devices. Applicable Procedure Codes: L6026, L6611, L6621, L6629, L6632, L6677, L6680, L6682, L6686, L6687, L6688, L6694, L6695, L6696, L6697, L6698, L6715, L6880, L6881, L6882, L6883, L6884, L6890, L6925, L6935, L6945, L6955, L6975, L7007, L7008, L7009, L7045, L7180, L7181, L7190, L7191, L7259, L7360, L7364, L7366, L7367, L7368, L7400, L7401, L7403, L7404, L8465, L8881.
Last Published 06.01.2024
Effective Date: 04.01.2024 – This policy addresses upper extremity myoelectric prosthetic devices. Applicable Procedure Codes: L6026, L6611, L6621, L6629, L6632, L6677, L6680, L6682, L6686, L6687, L6688, L6694, L6695, L6696, L6697, L6698, L6715, L6880, L6881, L6882, L6883, L6884, L6890, L6925, L6935, L6945, L6955, L6975, L7007, L7008, L7009, L7045, L7180, L7181, L7190, L7191, L7259, L7360, L7364, L7366, L7367, L7368, L7400, L7401, L7403, L7404, L8465, L8881.
Last Published 04.01.2024
In accordance with correct coding methodology, UnitedHealthcare determines reimbursement based on coding which specifically describes the services provided. S9083 is a global code which does not provide encounter level specificity, and code S9088 is considered informational only, as it pertains to the place of service and not the components of the specific service(s) provided. R0108 Flag: UCSDN, UCSTD
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses urine drug testing/screening. Applicable Procedure Codes: 80305, 80306, 80307, G0480, G0481, G0482, G0483.
Last Published 06.01.2024
This policy addresses uterine services and procedures. Applicable Procedure Codes: 0071T, 0072T, 37243, 37244, 58150, 58152, 58180, 58260, 58262, 58263, 58267, 58270, 58290, 58291, 58292, 58294, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573, 58662, 58999, 59812, 59840.
Last Published 06.01.2024
This policy addresses vaccinations/immunizations.
Last Published 06.20.2023
The Vaccines for Children (VFC) program was established in 1993 to serve children defined as "federally vaccine eligible" under section 1928(b)(2), which includes both "uninsured" and "Medicaid eligible" children. American Indian, Alaskan Native children and children whose insurance does not cover immunizations are also eligible for VFC.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses vaccines/immunizations.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses vaccines/immunizations.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses implantable vagus nerve stimulators and transcutaneous (non-implantable) vagus and trigeminal nerve stimulators. Applicable Procedure Codes: 61885, 61886, 64553, 64568, 64570, A4541, E0733, E0735, E0770, E1399, L8679, L8680, L8682, L8683, L8685, L8686, L8687, L8688.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses implantable vagus nerve stimulators and transcutaneous (non-implantable) vagus and trigeminal nerve stimulators. Applicable Procedure Codes: 61885, 61886, 64553, 64568, 64570, A4541, E0770, E0733, E 0735, E1399, K1016, L8679, L8680, L8682, L8683, L8685, L8686, L8687, L8688.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses implantable vagus nerve stimulators and transcutaneous (non-implantable) vagus and trigeminal nerve stimulators. Applicable Procedure Codes: 61885, 61886, 64553, 64568, 64570, A4541, E0733, E0735, E0770, E1399, L8679, L8680, L8682, L8683, L8685, L8686, L8687, L8688.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses implantable vagus nerve stimulators and transcutaneous (non-implantable) vagus and trigeminal nerve stimulators. Applicable Procedure Codes: 61885, 61886, 64553, 64568, 64570, E0770, E1399, K1016, K1017, K1020, L8679, L8680, L8682, L8683, L8685, L8686, L8687, L8688.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses implantable vagus nerve stimulators and transcutaneous (non-implantable) vagus and trigeminal nerve stimulators. Applicable Procedure Codes: 61885, 61886, 64553, 64568, 64570, A4541, E0733, E0735, E0770, E1399, L8679, L8680, L8682, L8683, L8685, L8686, L8687, L8688.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses implantable vagus nerve stimulators and transcutaneous (non-implantable) vagus and trigeminal nerve stimulators. Applicable Procedure Codes: 61885, 61886, 64553, 64568, 64570, A4541, E0733, E0735, E0770, E1399, L8679, L8680, L8682, L8683, L8685, L8686, L8687, L8688.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses implantable vagus nerve stimulators and transcutaneous (non-implantable) vagus and trigeminal nerve stimulators. Applicable Procedure Codes: 61885, 61886, 64553, 64568, 64570, A4541, E0733, E0735, E0770, E1399, L8679, L8680, L8682, L8683, L8685, L8686, L8687, L8688.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses implantable vagus nerve stimulators and transcutaneous (non-implantable) vagus and trigeminal nerve stimulators. Applicable Procedure Codes: 61885, 61886, 64553, 64568, 64570, A4541, E0733, E0735, E0770, E1399, L8679, L8680, L8682, L8683, L8685, L8686, L8687, L8688.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses implantable vagus nerve stimulators and transcutaneous (non-implantable) vagus and trigeminal nerve stimulators. Applicable Procedure Codes: 61885, 61886, 64553, 64568, 64570, E0770, E1399, K1016, K1017, K1020, L8679, L8680, L8682, L8683, L8685, L8686, L8687, L8688.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses implantable vagus nerve stimulators and transcutaneous (non-implantable) vagus and trigeminal nerve stimulators. Applicable Procedure Codes: 61885, 61886, 64553, 64568, 64570, A4541, E0733, E0735, E0770, E1399, L8679, L8680, L8682, L8683, L8685, L8686, L8687, L8688.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses Ventricular Assist Devices. Applicable Procedure Codes: 33975, 33976, 33979, 33981,33982, 33983, 33995, 33997.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Veopoz™ (pozelimab-bbfg) for the treatment of CD55-deficient protein-losing enteropathy (PLE) (i.e., CHAPLE disease). Applicable Procedure Codes: C9399, J3490, and J3590.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Veopoz™ (pozelimab-bbfg) for the treatment of CD55-deficient protein-losing enteropathy (PLE) (i.e., CHAPLE disease). Applicable Procedure Code: J9376.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Veopoz™ (pozelimab-bbfg) for the treatment of CD55-deficient protein-losing enteropathy (PLE) (i.e., CHAPLE disease). Applicable Procedure Codes: C9399, J3490, J3590.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Veopoz™ (pozelimab-bbfg) for the treatment of CD55-deficient protein-losing enteropathy (PLE) (i.e., CHAPLE disease). Applicable Procedure Code: J9376.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Veopoz™ (pozelimab-bbfg) for the treatment of CD55-deficient protein-losing enteropathy (PLE) (i.e., CHAPLE disease). Applicable Procedure Codes: C9399, J3490, J3590.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Veopoz™ (pozelimab-bbfg) for the treatment of CD55-deficient protein-losing enteropathy (PLE) (i.e., CHAPLE disease). Applicable Procedure Codes: C9399, J3490, and J3590.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses vertebral body tethering for the treatment of scoliosis. Applicable Procedure Codes: 0656T, 0657T, 22836, 22837, 22899.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses vertebral body tethering for the treatment of scoliosis. Applicable Procedure Codes: 0656T, 0657T, 22836, 22837, 22899.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses vertebral body tethering for the treatment of scoliosis. Applicable Procedure Codes: 0656T, 0657T, 22836, 22837, 22899.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses vertebral body tethering for the treatment of scoliosis. Applicable Procedure Codes: 0656T, 0657T, 22836, 22837, 22899.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses vertebral body tethering for the treatment of scoliosis. Applicable Procedure Codes: 0656T, 0657T, 22836, 22837, 22899.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses vertebral body tethering for the treatment of scoliosis. Applicable Procedure Codes: 0656T, 0657T, 22836, 22837, 22899.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses vertebral body tethering for the treatment of scoliosis. Applicable Procedure Codes: 0656T, 0657T, 22836, 22837, 22899.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses vertebral body tethering for the treatment of scoliosis. Applicable Procedure Code: 0656T, 0657T, 22836, 22837, 22899.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses vertebral body tethering for the treatment of scoliosis. Applicable Procedure Code: 0656T, 0657T, 22899.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses vertebral body tethering for the treatment of scoliosis. Applicable Procedure Code: 0656T, 0657T, 22836, 22837, 22899.
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses Veteran's Administration (VA) services, including emergency/urgent care services, skilled nursing facility (SNF) care, out-of-area services, and non-emergent services.
Last Published 04.01.2024
Effective 04.01.2024 – This policy addresses Veteran's Administration (VA) services, including emergency/urgent care services, skilled nursing facility (SNF) care, out-of-area services, and non-emergent services.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses video electroencephalographic (vEEG) monitoring and recording. Applicable Procedure Codes: 95700, 95711, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95722, 95724, 95726.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses video electroencephalographic (EEG) monitoring and recording. Applicable Procedure Codes: 95700, 95711, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95722, 95724, 95726.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses video electroencephalographic (vEEG) monitoring and recording. Applicable Procedure Codes: 95700, 95711, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95722, 95724, 95726.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses electroencephalographic (EEG) monitoring and video recording. Applicable Procedure Codes: 95700, 95711, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95722, 95724, 95726.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses video electroencephalographic (vEEG) monitoring and recording. Applicable Procedure Codes: 95700, 95711, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95722, 95724, 95726.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses video electroencephalographic (EEG) monitoring and recording. Applicable Procedure Codes: 95700, 95711, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95722, 95724, 95726.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses video electroencephalographic (EEG) monitoring and recording. Applicable Procedure Codes: 95700, 95711, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95722, 95724, 95726.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses video electroencephalographic (EEG) monitoring and recording. Applicable Procedure Codes: 95700, 95711, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95722, 95724, 95726.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses Viltepso® (viltolarsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1427.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses Viltepso® (viltolarsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1427.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses Viltepso® (viltolarsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedures Code: J1427.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses Viltepso® (viltolarsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedures Code: J1427.
Last Published 04.19.2024
This guideline address ethical principles of the medical profession and physicians’ responsibility in promoting the well-being of patients.
Last Published 01.27.2024
This policy identifies circumstances in which UnitedHealthcare Community Plan will reimburse physicians or other health care professionals for viral hepatitis serology testing.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses virtual upper gastrointestinal endoscopy. Applicable Procedure Codes: 76497, 76498.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses virtual upper gastrointestinal endoscopy. Applicable Procedure Codes: 76497, 76498.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses virtual upper gastrointestinal endoscopy. Applicable Procedure Codes: 76497, 76498.
Last Published 01.01.2024
Effective Date: 01.01.2024 - This policy addresses virtual upper gastrointestinal endoscopy. Applicable Procedure Codes: 76497, 76498.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses virtual upper gastrointestinal endoscopy. Applicable Procedure Codes: 76497, 76498.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses virtual upper gastrointestinal endoscopy. Applicable Procedure Codes: 76497, 76498.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses virtual upper gastrointestinal endoscopy. Applicable Procedure Codes: 76497, 76498.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses virtual upper gastrointestinal endoscopy. Applicable Procedure Codes: 76497, 76498.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses virtual upper gastrointestinal endoscopy. Applicable Procedure Codes: 76497, 76498.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses virtual upper gastrointestinal endoscopy. Applicable Procedure Codes: 76497, 76498.
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses vision care and services, including eye exams, eyeglasses, contact lenses, intraocular lenses (IOLs), surgical and laser procedures, and visual aids.
Last Published 06.01.2024
Effective 06.01.2024 – This policy addresses vision care and services, including eye examinations, eyeglasses, contact lenses, intraocular lenses (IOLs), surgical and laser procedures, and visual aids.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses vision services that are not routinely covered. Applicable Procedure Codes: V2025, V2399, V2499, V2531, V2630, V2631, V2632, V2702, V2750, V2756, V2761, V2762, V2780, V2781, V2784, V2786, V2788, V2797.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses occlusion therapy, pharmacologic penalization therapy, orthoptic or vision therapy, prism adaptation therapy, visual perception therapy, vision restoration therapy, and the use of visual information processing evaluations to diagnose reading or learning disabilities. Applicable Procedure Codes: 0687T, 0688T, 0704T, 0705T, 0706T, 92065, 92066, 92499.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses occlusion therapy, pharmacologic penalization therapy, orthoptic or vision therapy, prism adaptation therapy, visual perception therapy, vision restoration therapy, and the use of visual information processing evaluations to diagnose reading or learning disabilities. Applicable Procedure Codes: 0687T, 0688T, 0704T, 0705T, 0706T, 92065, 92066, 92499.
Last Published 02.01.2024
Effective Date: 02.01.2024 – This policy addresses occlusion therapy, pharmacologic penalization therapy, orthoptic or vision therapy, prism adaptation therapy, visual perception therapy, vision restoration therapy, and the use of visual information processing evaluations to diagnose reading or learning disabilities. Applicable Procedure Codes: 0687T, 0688T, 0704T, 0705T, 0706T, 92065, 92066, 92499.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses orthoptic or vision therapy. Applicable Procedure Codes: 0687T, 0688T, 0704T, 0705T, 0706T, 92065, 92066, 92499.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses occlusion therapy, pharmacologic penalization therapy, orthoptic or vision therapy, prism adaptation therapy, visual perception therapy, vision restoration therapy, and the use of visual information processing evaluations to diagnose reading or learning disabilities. Applicable Procedure Codes: 0687T, 0688T, 0704T, 0705T, 0706T, 92065, 92066, 92499.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses occlusion therapy, pharmacologic penalization therapy, orthoptic or vision therapy, prism adaptation therapy, visual perception therapy, vision restoration therapy, and the use of visual information processing evaluations to diagnose reading or learning disabilities. Applicable Procedure Codes: 0687T, 0688T, 0704T, 0705T, 0706T, 92065, 92499.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses occlusion therapy, pharmacologic penalization therapy, orthoptic or vision therapy, prism adaptation therapy, visual perception therapy, vision restoration therapy, and the use of visual information processing evaluations to diagnose reading or learning disabilities. Applicable Procedure Codes: 0687T, 0688T, 0704T, 0705T, 0706T, 92065, 92066, 92499.
Last Published 01.23.2024
This policy describes reimbursement for Vitamin D testing. Claims will be reimbursed if they include one of the codes on CMS. This policy describes reimbursement for Vitamin D testing. Claims will be reimbursed if they include one of the codes on CMS’ ICD-10 diagnosis codes list that supports Vitamin D testing or one of the additional diagnosis codes identified by UnitedHealthcare Community Plan.
Last Published 11.23.2022
This policy describes reimbursement for Vitamin D testing. Claims will be considered for reimbursement if they include one of the codes on CMS ICD-10 diagnosis codes list that supports Vitamin D testing.
Last Published 06.01.2024
This policy addresses testing for vitamin D deficiency. Applicable Procedure Codes: 82306, 82652.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Vyepti® (eptinezumab-jjmr) for the treatment of chronic and episodic migraine. Applicable Procedure Code: J3032.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Vyepti® (Eptinezumab) for the treatment of chronic and episodic migraine. Applicable Procedure Code: J3032.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Vyepti® (Eptinezumab) for the treatment of chronic and episodic migraine. Applicable Procedure Code: J3032.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Vyjuvek™ (beramagene geperpavec-svdt) for the treatment of wounds in patients with dystrophic epidermolysis bullosa (DEB). Applicable Procedure Code: J3401.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Vyjuvek™ (beramagene geperpavec-svdt) for the treatment of wounds in patients with dystrophic epidermolysis bullosa (DEB). Applicable Procedure Code: J3401.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Vyondys 53® (golodirsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1429.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Vyondys 53® (golodirsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedures Code: J1429.
Last Published 05.01.2023
Effective Date: 06.01.2023 – This policy addresses the use of Vyondys 53™ (golodirsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1429.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Vyondys 53™ (golodirsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedure Code: J1429.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Vyondys 53® (golodirsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedures Code: J1429.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses the use of Vyondys 53® (golodirsen) for the treatment of Duchenne muscular dystrophy (DMD). Applicable Procedures Code: J1429.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses the use of walkers. Applicable Procedure Codes: E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E0154, E0155, E0156, E0157, E0158, E0159.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses walkers. Applicable Procedure Codes: E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E0154, E0155, E0156, E0157, E0158, E0159.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses the use of walkers. Applicable Procedure Codes: E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E0154, E0155, E0156, E0157, E0158, E0159.
Last Published 07.01.2023
Effective Date: 07.01.2023 – This policy addresses walkers. Applicable Procedure Codes: E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E1054, E1055, E0156, E1057, E0158, E0159.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of walkers. Applicable Procedure Codes: A4636, A4637, E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E0154, E0155, E0156, E0157, E0158, E0159.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses walkers. Applicable Procedure Codes: A4636, A4637, E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E0154, E0155, E0156, E0157, E0158, E0159.
Last Published 05.01.2024
Effective 05.01.2024 – This policy addresses weight gain and weight loss programs, prescription drugs to treat obesity, and enhancement medications.
Last Published 05.01.2024
Effective 05.01.2024 – This policy addresses weight gain and weight loss programs and prescription drugs to treat obesity.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of white blood cell colony stimulating factors (CSFs), including the drug products Fulphila, Granix, Leukine, Neulasta, Neupogen, Nivestym, Nyvepria, Releuko, Udenyca, Zarxio, and Ziextenzo. Applicable Procedure Codes: C9096, J1442, J1447, J1449, J2506, J2820, J3490, J3590, Q5101, Q5108, Q5110, Q5111, Q5120, Q5122, Q5127, Q5130.
Last Published 05.01.2023
Effective Date: 06.01.2023 – This policy addresses whole exome and whole genome sequencing. Applicable Procedure Codes: 0036U, 0094U, 0212U, 0213U, 0214U, 0215U, 0335U, 0336U, 81415, 81416, 81417, 81425, 81426, 81427.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses whole exome and whole genome sequencing. Applicable Procedure Codes: 0094U, 0212U, 0213U, 0214U, 0215U, 0260U, 0264U, 0265U, 0266U, 0267U, 0335U, 0336U, 0425U, 0426U, 81415, 81416, 81417, 81425, 81426, 81427.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses whole exome and whole genome sequencing. Applicable Procedure Codes: 0036U, 0094U, 0212U, 0213U, 0214U, 0215U, 0265U, 0335U, 0336U, 0425U, 0426U, 81415, 81416, 81417, 81425, 81426, 81427.
Last Published 05.01.2024
Effective Date: 05.01.2024 – This policy addresses whole exome and whole genome sequencing. Applicable Procedure Codes: 0094U, 0212U, 0213U, 0214U, 0215U, 0260U,0264U, 0265U, 0266U, 0267U, 0335U, 0336U, 0425U, 0426U, 81415, 81416, 81417, 81425, 81426, 81427.
Last Published 04.01.2024
Effective Date: 02.01.2024 – This policy addresses wigs. Applicable Procedure Code: A9282.
Last Published 04.14.2024
Consistent with the Centers for Medicare and Medicaid Services (CMS), UnitedHealthcare will not reimburse for a Surgical or Other Invasive Procedure, or for services related to a particular Surgical or Other Invasive Procedure when any of the following are erroneously performed. 1) a different procedure altogether; 2) the correct procedure but on the wrong body part; or 3) the correct procedure but on the wrong patient. R0117 Flag: WRSDN
Last Published 03.15.2024
Consistent with the Centers for Medicare and Medicaid Services (CMS), UnitedHealthcare Community Plan will not reimburse for a Surgical or Other Invasive Procedure, or for services related to a particular Surgical or Other Invasive Procedure when any of the following are erroneously performed: 1) a different procedure altogether; 2) the correct procedure but on the wrong body part; or 3) the correct procedure but on the wrong patient. R0117
Last Published 02.02.2024
This UnitedHealthcare Community Plan reimbursement policy is based on information stated by CMS in its National Coverage Decision (NCD) 140.6 for Wrong Surgical or Other Invasive Procedure Performed on a Patient and is in alignment with the Leapfrog Group and the National Quality Forum (NQF) position on Serious Reportable Events in Healthcare.
Last Published 06.01.2024
This policy addresses the use of Xgeva®, Prolia® (denosumab) for the treatment of osteoporosis in postmenopausal women with a high risk of bone fractures. Applicable Procedure Code: J0897.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Xiaflex® (collagenase clostridium histolyticum) for the treatment of Dupuytren’s contracture and Peyronie’s disease. Applicable Procedure Codes: 20527, 26341, J0775.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Xiaflex® (collagenase clostridium histolyticum) for the treatment of Dupuytren’s contracture and Peyronie’s disease. Applicable Procedure Codes: 20527, 26341, J0775.
Last Published 04.01.2024
Effective Date: 04.01.2024 – This policy addresses the use of Xiaflex® (collagenase clostridium histolyticum) for the treatment of Dupuytren’s contracture and Peyronie’s disease. Applicable Procedure Codes: 20527, 26341, J0775.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Xiaflex® (collagenase clostridium histolyticum) for the treatment of Dupuytren’s contracture and Peyronie’s disease. Applicable Procedure Codes: 20527, 26341, J0775.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Xiaflex® (collagenase clostridium histolyticum) for the treatment of Dupuytren’s contracture and Peyronie’s disease. Applicable Procedure Codes: 20527, 26341, J0775.
Last Published 06.01.2024
This policy addresses the use of Xofigo® (radium Ra 223 dichloride) injection for the treatment of castration-resistant prostate cancer (CRPC), symptomatic bone metastases, and no known visceral metastatic disease. Applicable Procedure Codes: 79101, A9606.
Last Published 06.01.2024
Effective Date: 06.01.2024 – This policy addresses the use of Xolair® (omalizumab). Applicable Procedure Code: J2357.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Xolair® (omalizumab) for subcutaneous use for the treatment of moderate to severe persistent asthma, chronic urticaria, and nasal polyps. Applicable Procedure Code: J2357.
Last Published 06.01.2024
Effective Date: 10.01.2023 – This policy addresses the use of Xolair® (omalizumab) for subcutaneous use for the treatment of moderate to severe persistent asthma, chronic urticaria, and nasal polyps. Applicable Procedure Code: J2357.
Last Published 01.01.2023
Effective Date: 01.01.2023 – This policy addresses the use of Zilretta® (triamcinolone acetonide extended-release injectable suspension) for the treatment of osteoarthritis pain of the knee. Applicable Procedure Code: J3304.
Last Published 06.01.2024
This policy addresses the use of zoledronic acid (Zometa® & Reclast®). Applicable Procedure Code: J3489.
Last Published 01.01.2024
Effective Date: 01.01.2024 – This policy addresses the use of Zolgensma® (onasemnogene abeparvovec-xioi) for the treatment of spinal muscular atrophy (SMA). Applicable Procedure Code: J3399.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Zolgensma® (onasemnogene abeparvovec-xioi) for the treatment of spinal muscular atrophy (SMA). Applicable Procedure Code: J3399.
Last Published 12.01.2023
Effective Date: 12.01.2023 – This policy addresses the use of Zolgensma® (onasemnogene abeparvovec-xioi) for the treatment of spinal muscular atrophy (SMA). Applicable Procedure Code: J3399.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Zulresso® (brexanolone) for the treatment of postpartum depression (PPD) in adults. Applicable Procedure Code: J1632.
Last Published 03.01.2024
Effective Date: 03.01.2024 – This policy addresses the use of Zulresso® (brexanolone) for the treatment of postpartum depression (PPD) in adults. Applicable Procedure Code: J1632.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Zulresso® (brexanolone) for the treatment of postpartum depression (PPD) in adults. Applicable Procedure Code: J1632.
Last Published 11.01.2023
Effective Date: 11.01.2023 – This policy addresses the use of Zulresso® (brexanolone) for the treatment of postpartum depression (PPD) in adults. Applicable Procedure Code: J1632.