Surgery of the Hand or Wrist (for North Carolina Only)
Defines UnitedHealthcare coverage approach for hand and wrist surgical procedures for members in North Carolina and references InterQual criteria for specific medical necessity determinations.
Medical Records Documentation Used for Reviews: added language requiring the patient's medical record to fully support medical necessity and be legible, include history, exam, and pertinent diagnostic results, and be made available upon request.
Removed reference link to the guidelines titled Medical Records Documentation Used for Reviews.
Coverage Criteria
InterQual-based medical necessity
Covered when patient meets InterQual procedure-specific clinical criteria referenced below:
See InterQual links for each listed procedure category.
The listing of procedure or diagnosis codes in this policy is provided for reference only and does not imply that the service described by a code is covered or non‑covered. Benefit coverage decisions depend on applicable federal, state, and contractual requirements and laws, and inclusion of a code in this document does not guarantee reimbursement or claim payment.
This policy does not, by itself, declare services to be not medically necessary. Medical necessity determinations for the hand and wrist procedures referenced in this policy are made by applying the applicable InterQual procedure‑specific clinical criteria and the member's benefit/contractual terms; coverage may vary by plan and state requirements.
Applicable Procedure Codes
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