Medical Payment Policies

The purpose of UHA Medical Payment Policies is to guide coverage decisions and to provide information regarding the need for prior authorization and other administrative directives. They are not intended to influence treatment decisions and do not constitute plan authorization. Medical necessity must be clear. They are not explanations of benefits.

Medical policies can be highly technical and complex and are provided here for informational purposes. They do not constitute medical advice. Medical technology is constantly evolving and these medical policies are subject to change without notice. Additional medical policies may also be developed from time to time and some may be withdrawn from use as science advances. Clinical context can be highly variable.

Master Payment Policy

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• 3D Reconstruction Imaging

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• Advanced Practice Registered Nurse/Physician Assistant (APRN/PA)
• Ambulatory Surgery Centers (ASCs)
• Anesthesia Services for Gastrointestinal Endoscopic Procedures
• Applied Behavior Analysis for Autism Spectrum Disorders

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• Bio-Engineered Skin and Soft Tissue Substitutes
• Blepharoplasty and Repair of Blepharoptosis
• Breast Reconstruction Surgery

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• Cardiac Ablation Procedures
• Cardiovascular Disease Risk Assessment and Management Using Novel Biomarkers
• Cellulitis and Chronic/Complex Wound Care
• Chronic Opioid Therapy
• Clinical Trials
• Colorectal Cancer Screening Payment Policy
• Complementary and Alternative Medicine
• Comprehensive Genetic Testing Policy
• Conscious Sedation
• Continuous Glucose Monitoring of Interstitial Fluid
• COVID-19 Serology (IgG or IgM) Testing

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• Durable Medical Equipment

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• Eligibility for Dependents with Disabilities
• Emerging Technology
• End of Life Care
• Evaluation Management and Services

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• Gender Identity Services
• Growth Hormone Therapy

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• Habilitative Services
• Hepatic Neoplasm Treatment
• Home Health Care
• Home Infusion Pain Management
• Home IV Hydration Therapy
• Home Total Parenteral Nutrition for Adults
• Hyperbaric Oxygen Treatment (HBOT)
• Hyperhidrosis Treatment

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• In Vitro Fertilization
• Inpatient Protective Isolation
• Inpatient Skilled Nursing Facility
• Insulin Pumps - External
• Intensive Cardiac Rehabilitation: Dr. Dean Ornish Program

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• Kyphoplasty and Vertebroplasty

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• Medical Foods for Inborn Errors of Metabolism
• Medical Necessity Determination

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• Negative Pressure Wound Therapy
• Never Events and Hospital-Acquired Conditions

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• Occupational Therapy
• Open Access Hospice / Concurrent Care
• Orthodontic Services for Orofacial Anomalies
• Out-of-State Referrals for Medical Services
• Outpatient Psychotherapy Services
• Oxygen and Oxygen Equipment

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• Panniculectomy/Abdominoplasty
• Physical Therapy
• Preventive Health Guidelines: Newborn and Children
• Preventive Health Guidelines: Men
• Preventive Health Guidelines: Prenatal Care
• Preventive Health Guidelines: Women
• Prophylactic Mastectomy
• Prostate Cancer Treatment
• Psychological and Neuropsychological Testing

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• Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors
• Real-Time Intra-Fraction Target Tracking During Radiation Therapy
• Reduction Mammoplasty
• Residential Treatment for Chemical Dependence

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• Sleep Apnea Diagnosis
• Speech Therapy
• Spinal and Trigger Point Injections
• Spinal Cord Stimulators for Pain Management
• Stereotactic Radiosurgery (SRS) and Stereotactic Body Radiotherapy (SBRT)

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• Telehealth Services
• Transcatheter Aortic-Valve Implantation for Aortic Stenosis

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• Urine Drug Testing

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• Valvular Heart Disease
• Varicose Veins Treatment
• Virtual (CT) Colonoscopy

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