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imaging in a physician’s office or freestanding imaging center would reasonably be expected to delay care adversely and impact health outcome. All other advanced radiologic imaging procedures in the hospital outpatient department are considered not medically necessary. Related Commercial Policies • Breast Imaging for Screening and Diagnosing
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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, ...
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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.
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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
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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
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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
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Clinical Performance Guideline Medical Fertility Solutions ...
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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:
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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.
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www.uhcprovider.compervasive developmental disorders include autism, Rett's disorder, childhood disintegrative disorder, Asperger's disorder, and unspecified pervasive developmental disorder. E. …
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www.ucsfhealth.orgSend brief, pertinent medical records, including test results and imaging, that support the consultation. n. Send a copy of the patient’s insurance card (both sides) and HMO authorization if required. n. For help referring a patient, call (800) 444-2559. REFERRAL FORM . Date. No. of pages To UCSF practice . Fax From. Title Phone. Fax
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