CurrentUnitedHealthcarePolicy CS020KY.07

Cognitive Rehabilitation (for Kentucky Only)

UnitedHealthcare Community Plan medical policy governing outpatient Cognitive Rehabilitation (CR) services for members in Kentucky, including coverage rationale, applicable codes, definitions, clinical evidence summary, and coding/billing references. Coma stimulation is addressed as not medically necessary.

Policy Summary

PayerUnitedHealthcare

PolicyCognitive Rehabilitation (for Kentucky Only)

Policy CodePolicy CS020KY.07

Change TypeRevised

Effective DateDec 1, 2024

Next Review Date

Key ActionProviders must reference InterQual LOC: Outpatient Rehabilitation & Chiropractic for clinical coverage criteria to establish medical necessity for outpatient CR services.

POLICY UPDATE CHANGES

Clarified that the policy applies to outpatient Cognitive Rehabilitation services only.

Removed definition of 'Executive Functions'.

Updated definitions (Coma/Persistent Vegetative State, Coma Stimulation) and supporting sections (Description of Services, Clinical Evidence, References).

2Primary CPT/HCPCS groups listed

1Service explicitly not covered (Coma Stimulation)

InterQualPrimary clinical criteria source

Coverage Summary

This policy governs outpatient Cognitive Rehabilitation (CR) services for UnitedHealthcare Community Plan members in Kentucky. CR is a multidisciplinary outpatient program focused on improving cognitive functions (memory, attention, executive function, language, visuoperception) using restorative and compensatory approaches. The primary clinical criteria source for medical necessity determinations is InterQual® LOC: Outpatient Rehabilitation & Chiropractic. The coverage stance is mixed: CR is considered proven and medically necessary under certain circumstances (see InterQual for specific criteria), while Coma Stimulation (also called coma arousal or multisensory stimulation) is unproven and not medically necessary for any indication.

Key policy facts

Effective Date2024-12-01

Last Review2024-12-01

Next Review

Policy NumberCS020KY.07

Scope SummaryUnitedHealthcare Community Plan medical policy governing outpatient Cognitive Rehabilitation (CR) services for members in Kentucky, including coverage rationale, applicable codes, definitions, clinical evidence summary, and coding/billing references. Coma stimulation is addressed as not medically necessary.

Primary clinical criteria sourceInterQual