Coverage Rationale Applicable Codes
Listing of a code in this policy does not imply that the service described by the code is a covered or non- covered health service. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may ... UnitedHealthcare Commercial Medical Policy Effective 01/01/2022 .
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Coverage Summary - UHCprovider.com Home
www.uhcprovider.comThe benefit information in this Coverage Summary is based on existing national coverage ... Also see the Medicare Prescription Drug Benefit Manual,Chapter 6, ...
UnitedHealthcare Group Medicare Advantage …
www.uhcprovider.comUnitedHealthcare® Group Medicare Advantage (PPO) Plan Network Care Provider Quick Reference Guide Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates.
Shoulder Replacement Surgery (Arthroplasty)
www.uhcprovider.comShoulder Replacement Surgery (Arthroplasty) ... FDA-approved reverse shoulder replacement surgery devices are generally approved for gross rotator cuff deficiency. The patient's joint must be anatomically and structurally suited to receive the selected implant(s), and a functional
NEUROMUSCULAR ELECTRICAL STIMULATION …
www.uhcprovider.comNeuromuscular Electrical Stimulation (NMES) (NCD 160.12) Page 2 of 3 UnitedHealthcare Medicare Advantage Policy Guideline Approved 08/09/2017
APREPITANT FOR CHEMOTHERAPY-INDUCED …
www.uhcprovider.comChemotherapy-induced nausea and vomiting (CINV) can range from mild to severe, with the most severe cases resulting in dehydration, malnutrition, metabolic imbalances, and potential withdrawal from future chemotherapy
Clinical Performance Guideline Medical Fertility Solutions ...
www.uhcprovider.comClinical Performance Guideline Fertility Solutions Infertility Medical Necessity Guideline Purpose: To provide an understanding of infertility treatment, issues surrounding infertility surgery, and issues surrounding multiple embryo transfers among individuals faced with the potential loss of fertility.
EXTRACORPOREAL SHOCK WAVE TREATMENT (ESWT)
www.uhcprovider.comExtracorporeal Shock Wave Treatment (ESWT) Page 1 of 4 ... Extracorporeal shock wave therapy (ESWT), using either a high- or low-dose protocol or a radial wave, is considered not medically necessary for all indications, including but not limited to the treatment of:
Pervasive Developmental Disorder and Autism Spectrum …
www.uhcprovider.comPervasive Developmental Disorder and Autism Spectrum Disorder: Benefit Interpretation Policy (Effective 01/01/2018) 3 Proprietary Information of UnitedHealthcare.
Pervasive Developmental Disorder and Autism Spectrum …
www.uhcprovider.compervasive developmental disorders include autism, Rett's disorder, childhood disintegrative disorder, Asperger's disorder, and unspecified pervasive developmental disorder. E. …
Approval Date: October 10, 2018 - UHCprovider.com Home
www.uhcprovider.comRetinal Prosthesis Page 1 of 3 UnitedHealthcare Medicare Advantage Policy Guideline Approved 10/10/2018 Proprietary Information of UnitedHealthcare.
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