Omnibus Codes – Commercial Medical Policy

← Back to document page

Omnibus Codes Page 1 of 188 UnitedHealthcare Commercial Medical Policy Effective 04/01/2022 Proprietary Information of UnitedHealthcare. Copyright 2022 United HealthCare Services, Inc. UnitedHealthcare Commercial Medica l Policy Omnibus Codes Policy Number: 2022T0535LL Effective Date: April 1, 2022 Instructions for Use Table of Contents Page Coverage Summary ........................................ ............................... 1 Coverage Rationale/Clinical Evidence ....................................... 12 Policy History/Revision Information ........................................ . 187 Instructions for 188 Coverage Summary All CPT/HCPCS Codes /services addressed in this Policy are noted in the table below. Click the code link to be directed to the full coverage rationale and clinical evidence applicable to each of the listed procedures.

0398T Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation lesion, intracranial for movement disorder including stereotactic navigation and frame placement when performed . Unproven . 0408T: Insertion or replacement of permanent cardiac contractility modulation system,

  Policy, Code, Medical, Commercial, Focused, Ultrasound, Omnibus, Focused ultrasound, Omnibus codes commercial medical policy