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Procedures, DME, and Other Services


Drugs

Procedures, DME and Other Services Requiring Preauthorization

The procedures, durable medical equipment (DME) items and other services for which UnitedHealthcare requires preauthorization are listed below.* UnitedHealthcare reserves the right to change this list at any time without notice. UnitedHealthcare does not guarantee that this list is complete or current. Contact a UnitedHealthcare Customer Service Representative discuss your health plan’s preauthorization requirements and/or to confirm benefit coverage for a procedure, DME item or other service.

*Note: This list does not apply to TennCare plan members. Please call 1-800-690-1606 for TennCare preauthorization information.

Procedures, DME and Other Services Requiring Preauthorization

UnitedHealthcare uses MCGTM Care Guidelines (formerly Milliman Care Guidelines®), which are nationally recognized clinical guidelines, to assist clinicians in making informed decisions in many health care settings. This includes acute and subacute medical, rehabilitation, skilled nursing facilities, home health care and ambulatory facilities. You may request a copy of the clinical criteria from your Case Reviewer or by calling the UnitedHealthcare of the River Valley Physician Voice Portal at 800-747-1446.


Medical providers are independent contractors, not employees or agents of the health plan. Our members and their medical providers, not the health plan, decide what medical care members receive and how they receive it. UnitedHealthcare only determines what medical care will be paid for under members' benefit plan. UnitedHealthcare does not provide medical treatment or advice. We encourage you to talk to your doctor about any health concerns you may have.



 
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