UnitedHealthcare (UHC) recently updated its Medical and Drug Policies and Coverage Determination Guidelines for UnitedHealthcare Commercial Plans to include updated documentation requirements and clinical coverage criteria effective for dates of service on or after August 1, 2020. Per the FAQ, UHC will now require the submission of images as part of the prior authorization process for the following services.

• Surgical Treatment for Spine Pain
• Knee Replacement Surgery (Arthroplasty), Total and Partial
• Total Artificial Disc Replacement for the Spine
• Hip Resurfacing and Replacement Surgery (Arthroplasty)
• Functional Endoscopic Sinus Surgery (FESS)
• Balloon Sinus Ostial Dilation
• Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins
• Shoulder Replacement Surgery (Arthroplasty)
• Skin and Soft Tissue Substitutes

UHC has advised that the update to imaging requirements varies by policy and is not necessarily limited to the policies listed above. For specific directions on how to upload images to UHC see the FAQ. Physicians should refer to the applicable UHC medical policies or the Medical Record Requirements for Pre-Service Reviews to determine if an unlisted policy requires image submission.

Providers who have questions or need further clarification should contact the Provider Services number on the back of the patient’s UnitedHealthcare ID card or UHC Network Management at (866) 574-6088.