Transcription of Obstetrical Ultrasonography – Oxford Clinical Policy
{{id}} {{{paragraph}}}
Example: barber
Obstetrical Ultrasonography – Oxford Clinical Policy
Obstetrical Ultrasonography Page 1 of 5 UnitedHealthcare Oxford Clinical Policy Effective 11/01/2021 1996-2021, Oxford Health Plans, LLC UnitedHealthcare Oxford Clinica l Policy Obstetrical Ultrasonography Policy Number: RADIOLOGY T2 Effective Date: November 1, 2021 Instructions for Use Table of Contents Page Coverage Rationale .. 1 Prior Authorization Requirements .. 2 Applicable Codes .. 2 4 Benefit Considerations .. 4 References .. 4 Policy History/Revision Information .. 5 Instructions for Use .. 5 Coverage Rationale See Benefit Considerations This Policy has three components: 1. Utilization Management Up to three ultrasounds will be reimbursed per member, per pregnancy, without prior authorization as outlined in section 2. and 3. of this Policy . The fourth and subsequent Obstetrical ultrasound procedure per member per pregnancy performed by a participating provider as outlined are subject to utilization review (prior authorization) by eviCore healthcare.
participating providers (as outlined in this policy). New Jersey Small, New Jersey School Board, and New Jersey Municipality Groups . New or Renewed prior to Jan. 1, 2021 . Services indicated as requiring prior authorization require medical necessity review. This review may be requested prior to service.
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: