Surgery Hand Wrist Pa Cs
State-specific UnitedHealthcare medical policy (Pennsylvania only) defining that hand and wrist surgeries are medically necessary in certain circumstances and deferring to InterQual procedural criteria for clinical coverage determinations; includes an applicable CPT code list and references Pennsylvania Code Title 55, Chapter 1101.
07/01/2025 routine review; no change to coverage guidelines; archived previous policy version CS343PA.F
Coverage Summary
This Pennsylvania-specific UnitedHealthcare medical policy (Policy Number: CS343PA.G) covers surgical procedures of the hand and wrist and states that such surgeries are covered with criteria when the referenced InterQual procedural criteria are met. The policy is effective 07/01/2025 and was last reviewed on 07/01/2025. Policy history notes a routine review with no change to coverage guidelines and archival of the previous version.
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