Surgery of the Hand or Wrist
Defines UnitedHealthcare coverage stance and directs use of InterQual clinical criteria for specific hand and wrist surgical procedures; applies to commercial members except where state-specific policies override.
Medical Records Documentation Used for Reviews was added to indicate that benefit coverage is determined by federal, state, contractual requirements and applicable laws that may require coverage for a specific service.
Language was added that medical records documentation may be required to assess whether the member meets clinical criteria for coverage but does not guarantee coverage.
Previous policy version CS343.H was archived and replaced by this version.
Coverage Criteria
Procedures covered per InterQual
Covered when InterQual criteria for the specific procedure are met.
Refer to the InterQual CP for the detailed clinical criteria and decision support pathways.
This Medical Policy does not apply in the states listed in the Application section. Refer to the state-specific policy or guideline where noted (for example: Idaho, Kansas, Kentucky, New Mexico, Ohio, and Pennsylvania each reference a state-specific 'Surgery of the Hand or Wrist' policy).
Medical records documentation may be requested to determine whether the member meets the InterQual clinical criteria for the requested hand or wrist procedure. Submission of records does not guarantee coverage; coverage decisions are based on whether documentation shows the member meets applicable clinical criteria, benefit plan terms, and any applicable laws or state requirements.
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