UnitedHealthcare Revises Several Therapy Coverage Determination Guidelines

UnitedHealthcare (UHC) has revised several therapy coverage determination guidelines and medical policies related to their UHC Commercial and Affiliate Plans, UHC Exchange Plans, and UHC Community Plan. Continue reading below to access the revised guidelines and medical policies that are applicable to your state.

UHC Commercial Medical Policy Update

The following coverage determination guideline has been revised and applies to all 50 states. This Coverage Determination Guideline may also be applied to Medicare Advantage plans in certain instances. In the absence of a Medicare National Coverage Determination (NCD), Local Coverage Determination (LCD), or other Medicare coverage guidance, CMS allows a Medicare Advantage Organization (MAO) to create its own coverage determinations, using objective evidence-based rationale relying on authoritative evidence:

UHC Oxford Medical Policy Update

The following reimbursement policy has been revised and applies to providers in all 50 states:

UHC West Benefit Interpretation Policy Update

The following policy has been revised and impacts the state of California:

UHC Value and Balance Exchange Medical Policy Update

The following policies have been revised and impacts the states of Arizona, Maryland, North Carolina, Oklahoma, Tennessee, Virginia, and Washington:

UHC Community Plan Medical Policy Update

The following policies have been revised and impacts the states of Arizona, California, Hawaii, Kansas, Maryland, Michigan, New York, Ohio, Rhode Island, Virginia, Washington, and Wisconsin:

The following policies have been revised and impacts the state of Nebraska:

UHC Community Plan Coverage Determination Guideline

The following policies have been revised and impacts the state of Kentucky:

I hope you found this article informative as well as helpful to your therapy practice and/or therapy department. Thank you for being a Gold Member!