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Radiology Procedures Requiring Precertification for ...

Radiology Procedures Requiring Precertification for eviCore healthcare Arrangement Page 1 of 13 UnitedHealthcare Oxford Clinical Policy Effective 12/01/2017 1996-2017, Oxford Health Plans, LLC Radiology Procedures Requiring Precertification FOR EVICORE HEALTHCARE ARRANGEMENT Policy Number: Radiology T2 Effective Date: December 1, 2017 Table of Contents Page INSTRUCTIONS FOR USE .. 1 CONDITIONS OF COVERAGE .. 1 BENEFIT CONSIDERATIONS .. 2 COVERAGE RATIONALE .. 2 BACKGROUND .. 3 APPLICABLE CODES .. 3 POLICY HISTORY/REVISION INFORMATION .. 13 INSTRUCTIONS FOR USE This Clinical Policy provides assistance in interpreting Oxford benefit plans.

Radiology Procedures Requiring Precertification for eviCore healthcare Arrangement Page 1 of 13 UnitedHealthcare Oxford Clinical Policy Effective 06/01/2018

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