UnitedHealthcare Oxford Clinical and Administrative Policies (2024)

Ablative Treatment for Spinal Pain – Oxford Clinical Policy Abnormal Uterine Bleeding and Uterine Fibroids – Oxford Clinical Policy Accreditation Requirements for Radiology Services – Oxford Administrative Policy Airway Clearance Devices – Oxford Clinical Policy Ambulance Services – Oxford Clinical Policy Apheresis – Oxford Clinical Policy Athletic Pubalgia Surgery – Oxford Clinical Policy Autologous Cellular Therapy – Oxford Clinical Policy Balloon Sinus Ostial Dilation – Oxford Clinical Policy Bariatric Surgery – Oxford Clinical Policy Beds and Mattresses – Oxford Clinical Policy Breast Imaging for Screening and Diagnosing Cancer – Oxford Clinical Policy Breast Reconstruction – Oxford Clinical Policy Breast Reduction Surgery – Oxford Clinical Policy Bronchial Thermoplasty – Oxford Clinical Policy Brow Ptosis and Eyelid Repair – Oxford Clinical Policy Cardiac Event Monitoring – Oxford Clinical Policy Cardiology Procedures for eviCore healthcare Arrangement – Oxford Clinical Policy Cardiovascular Disease Risk Tests – Oxford Clinical Policy Carrier Testing Panels for Genetic Diseases – Oxford Clinical Policy Category III Codes – Oxford Clinical Policy Catheter Ablation for Atrial Fibrillation – Oxford Clinical Policy Cell-Free Fetal DNA Testing – Oxford Clinical Policy Chelation Therapy for Non-Overload Conditions – Oxford Clinical Policy Chromosome Microarray Testing (Non-Oncology Conditions) – Oxford Clinical Policy Clinical Trials – Oxford Clinical Policy Cochlear Implants – Oxford Clinical Policy Collagen Crosslinks and Biochemical Markers of Bone Turnover – Oxford Clinical Policy Computer-Assisted Surgical Navigation for Musculoskeletal Procedures – Oxford Clinical Policy Computerized Dynamic Posturography – Oxford Clinical Policy Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes – Oxford Clinical Policy Core Decompression for Avascular Necrosis – Oxford Clinical Policy Corneal Collagen Cross-Linking – Oxford Clinical Policy Corneal Hysteresis and Intraocular Pressure Measurement – Oxford Clinical Policy Cosmetic and Reconstructive Procedures – Oxford Clinical Policy Credentialing Guidelines: Participation in the eviCore healthcare Network – Oxford Administrative Policy Cytological Examination of Breast Fluids for Cancer Screening or Diagnosis – Oxford Clinical Policy Deep Brain and Cortical Stimulation – Oxford Clinical Policy Diagnostic Dynamic Spinal Visualization and Vertebral Motion Analysis – Oxford Clinical Policy Discogenic Pain Treatment – Oxford Clinical Policy Durable Medical Equipment, Orthotics, Medical Supplies, and Repairs/Replacements – Oxford Clinical Policy Elective Inpatient Services – Oxford Clinical Policy Electric Tumor Treatment Field Therapy – Oxford Clinical Policy Electrical and Ultrasound Bone Growth Stimulators – Oxford Clinical Policy Electrical Stimulation for the Treatment of Pain and Muscle Rehabilitation – Oxford Clinical Policy Electromagnetic Therapy for Wounds – Oxford Clinical Policy Electroretinography – Oxford Clinical Policy Embolization of the Ovarian and Iliac Veins for Pelvic Congestion Syndrome – Oxford Clinical Policy Enteral Nutrition (Oral and Tube Feeding) – Oxford Clinical Policy Epidural Steroid Injections for Spinal Pain – Oxford Clinical Policy Epiduroscopy, Epidural Lysis of Adhesions and Discography – Oxford Clinical Policy Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue Wounds – Oxford Clinical Policy Facet Joint and Medial Branch Block Injections for Spinal Pain – Oxford Clinical Policy Fecal Calprotectin Testing – Oxford Clinical Policy Fecal Microbiota Transplantation – Oxford Clinical Policy Follow-Up Care Rendered in an Emergency Room Site of Service – Oxford Administrative Policy Functional Endoscopic Sinus Surgery (FESS) – Oxford Clinical Policy Gastrointestinal Motility Disorders, Diagnosis and Treatment – Oxford Clinical Policy Gastrointestinal Pathogen Nucleic Acid Detection Panel Testing for Infectious Diarrhea – Oxford Clinical Policy Gender Dysphoria Treatment – Oxford Clinical Policy Genetic Testing for Cardiac Disease – Oxford Clinical Policy Genetic Testing for Hereditary Cancer – Oxford Clinical Policy Genetic Testing for Neuromuscular Disorders – Oxford Clinical Policy Glaucoma Surgical Treatments – Oxford Clinical Policy Gynecomastia Surgery – Oxford Clinical Policy Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) – Oxford Clinical Policy Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable – Oxford Clinical Policy Home Health, Skilled, and Custodial Care Services – Oxford Clinical Policy Home Hemodialysis – Oxford Clinical Policy Home Traction Therapy – Oxford Clinical Policy Hospital Services: Observation and Inpatient – Oxford Clinical Policy Hyperbaric Oxygen Therapy And Topical Oxygen Therapy – Oxford Clinical Policy Hysterectomy – Oxford Clinical Policy Implantable Beta-Emitting Microspheres for Treatment of Malignant Tumors – Oxford Clinical Policy Implanted Electrical Stimulator for Spinal Cord – Oxford Clinical Policy Implanted Spinal Drug Delivery Systems – Oxford Clinical Policy In-Office Laboratory Testing and Procedures List – Oxford Administrative Policy Infertility Diagnosis, Treatment, and Fertility Preservation – Oxford Clinical Policy Inhaled Nitric Oxide Therapy – Oxford Clinical Policy Injectables for Reconstructive Procedures – Oxford Clinical Policy Intensity-Modulated Radiation Therapy – Oxford Clinical Policy Interspinous Fusion and Decompression Devices – Oxford Clinical Policy Intraoperative Hyperthermic Intraperitoneal Chemotherapy (HIPEC) – Oxford Clinical Policy Intrauterine Fetal Surgery – Oxford Clinical Policy Left Atrial Appendage Closure (Occlusion) – Oxford Clinical Policy Light and Laser Therapy – Oxford Clinical Policy Liposuction for Lipedema – Oxford Clinical Policy Lithotripsy for Salivary Stones – Oxford Clinical Policy Lower Extremity Endovascular Procedures – Oxford Clinical Policy Lower Extremity Prosthetics – Oxford Clinical Policy Macular Degeneration Treatment Procedures – Oxford Clinical Policy Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan – Site of Service – Oxford Clinical Policy Manipulation Under Anesthesia – Oxford Clinical Policy Manipulative Therapy – Oxford Clinical Policy Mechanical Stretching Devices – Oxford Clinical Policy Minimally Invasive Procedures for Gastric and Esophageal Diseases – Oxford Clinical Policy Minimally Invasive Spine Surgery Procedures – Oxford Clinical Policy Mobility Devices, Options, and Accessories – Oxford Clinical Policy Molecular Oncology Companion Diagnostic Testing – Oxford Clinical Policy Molecular Oncology Testing for Hematologic Cancer Diagnosis, Prognosis, and Treatment Decisions – Oxford Clinical Policy Molecular Oncology Testing for Solid Tumor Cancer Diagnosis, Prognosis, and Treatment Decisions – Oxford Clinical Policy Motorized Spinal Traction – Oxford Clinical Policy Negative Pressure Wound Therapy – Oxford Clinical Policy Nerve Graft to Restore Erectile Function During Radical Prostatectomy – Oxford Clinical Policy Neurophysiologic Testing and Monitoring – Oxford Clinical Policy Neuropsychological Testing Under the Medical Benefit – Oxford Clinical Policy Noncontact Warming Therapy, Ultrasound Therapy, and Fluorescence Imaging for Wounds – Oxford Clinical Policy Obstetrical Ultrasonography – Oxford Clinical Policy Obstructive and Central Sleep Apnea Treatment – Oxford Clinical Policy Occipital Nerve Injections and Ablation (Including Occipital Neuralgia and Headache) – Oxford Clinical Policy Office-Based Procedures – Site of Service – Oxford Clinical Policy Omnibus Codes – Oxford Clinical Policy Orthognathic (Jaw) Surgery – Oxford Clinical Policy Otoacoustic Emissions Testing – Oxford Clinical Policy Outpatient Surgical Procedures – Site of Service – Oxford Clinical Policy Oxford's Outpatient Imaging Self-Referral Policy – Oxford Clinical Policy Panniculectomy and Body Contouring Procedures – Oxford Clinical Policy Participating Providers Using Non-Participating Providers Protocol – Oxford Administrative Policy Patient Lifts – Oxford Clinical Policy Pectus Deformity Repair – Oxford Clinical Policy Pediatric Gait Trainers and Standing Systems – Oxford Clinical Policy Percutaneous Neuroablation for Pancreatic Cancer Pain, Severe Cancer Pain, and Trigeminal Neuralgia – Oxford Clinical Policy Percutaneous Patent Foramen Ovale (PFO) Closure – Oxford Clinical Policy Percutaneous Vertebroplasty and Kyphoplasty – Oxford Clinical Policy Pharmacogenetic Panel Testing – Oxford Clinical Policy Plagiocephaly and Craniosynostosis Treatment – Oxford Clinical Policy Pneumatic Compression Devices – Oxford Clinical Policy Preimplantation Genetic Testing and Related Services – Oxford Clinical Policy Preventive Care Services – Oxford Clinical Policy Private Duty Nursing Services – Oxford Clinical Policy Prolotherapy and Platelet Rich Plasma Therapies – Oxford Clinical Policy Prostate Surgeries and Interventions – Oxford Clinical Policy Proton Beam Radiation Therapy – Oxford Clinical Policy Radiation Therapy: Fractionation, Image-Guidance, and Special Services – Oxford Clinical Policy Radiology Procedures for eviCore healthcare Arrangement – Oxford Clinical Policy Radiopharmaceuticals and Contrast Media – Oxford Clinical Policy Rhinoplasty and Other Nasal Procedures – Oxford Clinical Policy Sacral Nerve Stimulation for Urinary and Fecal Indications – Oxford Clinical Policy Sacroiliac Joint Interventions – Oxford Clinical Policy Screening Colonoscopy Procedures – Site of Service – Oxford Clinical Policy Sensory Integration Therapy and Auditory Integration Training – Oxford Clinical Policy Site of Service Differential – Oxford Administrative Policy Skin and Soft Tissue Substitutes – Oxford Clinical Policy Sleep Studies – Oxford Clinical Policy Speech Generating Devices – Oxford Clinical Policy Spinal Fusion and Bone Healing Enhancement Products – Oxford Clinical Policy Spinal Fusion and Decompression – Oxford Clinical Policy Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery – Oxford Clinical Policy Succeeding Carrier for Inpatient Admissions – Oxford Administrative Policy Surgery of the Ankle – Oxford Clinical Policy Surgery of the Elbow – Oxford Clinical Policy Surgery of the Foot – Oxford Clinical Policy Surgery of the Hand or Wrist – Oxford Clinical Policy Surgery of the Hip – Oxford Clinical Policy Surgery of the Knee – Oxford Clinical Policy Surgery of the Shoulder – Oxford Clinical Policy Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins – Oxford Clinical Policy Surgical Treatment of Lymphedema – Oxford Clinical Policy Sympathetic Blockade – Oxford Clinical Policy Total Artificial Disc Replacement for the Spine – Oxford Clinical Policy Total Artificial Heart and Ventricular Assist Devices – Oxford Clinical Policy Transanal Minimally Invasive Surgical Procedures – Oxford Clinical Policy Transcatheter Heart Valve Procedures – Oxford Clinical Policy Transcranial Magnetic Stimulation – Oxford Clinical Policy Transpupillary Thermotherapy – Oxford Clinical Policy Treatment of Temporomandibular Joint Disorders – Oxford Clinical Policy Umbilical Cord Blood Harvesting and Storage for Future Use – Oxford Clinical Policy Unicondylar Spacer Devices for Treatment of Pain or Disability – Oxford Clinical Policy Upper Extremity Prosthetic Devices – Oxford Clinical Policy Vagus and External Trigeminal Nerve Stimulation – Oxford Clinical Policy Vertebral Body Tethering for Scoliosis – Oxford Clinical Policy Video Electroencephalographic (vEEG) Monitoring and Recording – Oxford Clinical Policy Virtual Upper Gastrointestinal Endoscopy – Oxford Clinical Policy Visual Information Processing Evaluation and Orthoptic and Vision Therapy – Oxford Clinical Policy Walkers – Oxford Clinical Policy Whole Exome and Whole Genome Sequencing (Non-Oncology Conditions) – Oxford Clinical Policy Wigs – Oxford Administrative Policy