CurrentUnitedHealthcarePolicy N/A

Massachusetts: Nonmedication alternatives for pain management

Quick reference guide listing coverage status and prior authorization requirements for non-medication pain management services and alternative therapies for Massachusetts members (small group and large group distinctions).

Policy Summary

PayerUnitedHealthcare

PolicyMassachusetts: Nonmedication alternatives for pain management

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionDocument clinical indications and meet the plan's clinical requirements before submitting claims for services listed as 'Covered if clinical requirements are met'.

POLICY UPDATE CHANGES

No material changes

11Services Listed

MostCovered without PA (large group)

1Not covered (small group)

Coverage Summary

This quick reference summarizes UnitedHealthcare Massachusetts coverage positions for non-medication alternatives to opioids for pain management, highlighting differences between small-group and large-group plans and noting where clinical criteria apply for coverage. It lists coverage and prior authorization status by service to guide providers on which non-pharmacologic therapies are covered and when plan-specific clinical requirements are required.

Medical-Necessity / Coverage by Service

General coverage by service and group size

Coverage and prior authorization status vary by service and by Small group vs Large group plans:

ALL of the following

Acupuncture
- Small group: Not covered.
- Large group: Covered; no prior authorization.
Chiropractic
- Small group: Covered; no prior authorization.
- Large group: Covered; no prior authorization.
Physical therapy
- Small group: Covered; no prior authorization.
- Large group: Covered; no prior authorization.
Occupational therapy
- Small group: Covered; no prior authorization.
- Large group: Covered; no prior authorization.
Physician medicine/rehabilitation
- Small group: Covered; no prior authorization.
- Large group: Covered; no prior authorization.
Cognitive behavioral therapy (CBT)
- Small group: Covered; no prior authorization.
- Large group: Covered; no prior authorization.
Nutrition counseling
- Small group: Covered; no prior authorization.
- Large group: Covered; no prior authorization.
Osteopathic manipulative medicine
- Small group: Covered; no prior authorization.
- Large group: Covered; no prior authorization.
Interventional management (nerve block) for pain
- Small group: Covered if clinical requirements are met.
- Large group: Covered if clinical requirements are met.
Spine surgery
- Small group: Covered if clinical requirements are met.
- Large group: Optional (buy-up).
Transcutaneous Electrical Nerve Stimulation (TENS) unit
- Small group: Covered if clinical requirements are met.
- Large group: Covered if clinical requirements are met.

Provider Actions & Documentation

Prior Authorization

Prior authorization requirement when clinical criteria apply

For services listed as "Covered if clinical requirements are met" (for example: interventional nerve block, spine surgery for small group, TENS unit for small group), providers must meet the plan's clinical requirements prior to coverage. The guide notes no prior authorization for many rehabilitative services but does not provide specific prior authorization forms or codes.

Documentation Required

Clinical requirements documentation

When coverage is conditional on clinical requirements, providers should document clinical indications and criteria per the plan's requirements to support coverage. This quick reference does not provide the specific clinical criteria or documentation templates.

Document clinical indications and criteria per plan requirements; specific criteria not provided in quick reference.