Transcription of Computed Tomography (NCD 220.1) - UHCprovider.com
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Computed Tomography (NCD ) Page 1 of 7 UnitedHealthcare Medicare Advantage Policy Guideline Approved 04/08/2020 Proprietary Information of UnitedHealthcare. Copyright 2020 United HealthCare Services, Inc. Computed Tomography (NCD ) Guideline Number: Approval Date: April 8, 2020 Table of Contents Page POLICY SUMMARY .. 1 APPLICABLE CODES .. 2 PURPOSE .. 5 REFERENCES .. 5 GUIDELINE HISTORY/REVISION INFORMATION .. 7 TERMS AND CONDITIONS .. 7 POLICY SUMMARY Overview Diagnostic examinations of the head (head scans) and of other parts of the body (body scans) performed by computerized Tomography (CT) scanners are covered if medical and scientific literature and opinion support the effective use of a scan for the condition, and the scan is: (1) reasonable and necessary for the individual patient; and (2) performed on a model of CT equipment that meets the criteria below.
See also, 68 Fed. Reg. 63692, 63693 (November 7, 2003). UnitedHealthcare Medicare Advantage Policy Guideline Approved 05/12/2021 Proprietary Information of UnitedHealthcare.
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