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Computed Tomography (NCD 220.1) - UHCprovider.com

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

Applicable Codes ..... 3 References ... and does not require hospitalization. Guidelines ... CPT Code Description 70450 . Computed tomography, head or brain; without contrast material ; 70460 ;

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