Private Payor: United Healthcare Spinal Ultrasonography Medical Policy


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Topic Private Payor: United Healthcare Spinal Ultrasonography Medical Policy
Background Private Payor: United Healthcare Spinal Ultrasonography Medical Policy Updated description of services to reflect most current clinical evidence and references. Updated list of applicable CPT codes; removed 76880. Spinal and paraspinal ultrasonography is proven in newborns and infants for the evaluation of suspected spinal disorders (e.g., congenital cord anomalies, spinal ord tumors, vascular malformations and birth-related trauma). Spinal and paraspinal ultrasonography (including extremities, pelvis, or soft tissues of the head and neck) are unproven for the following uses: to diagnose and manage spinal pain and radiculopathies to guide rehabilitation of neuromusculoskeletal disorders and spinal pain There is insufficient evidence in the peerreviewed medical literature to establish the efficacy or clinical value of spinal and paraspinal ultrasonography as a diagnostic tool in the management of back pain, radiculopathies or for monitoring of therapies. The use of ultrasound imaging to guide rehabilitation is under investigation. More research is needed to define the role of rehabilitative ultrasound imaging.
Regulating Body UnitedHealthcare - Medical Policy Bulletin
Compliance Date 11/1/2011
Consequences Billing with an outdated CPT code or in a manner that does not meet the medical necessity requirements in the policy may result in nonpayment.
Next Steps Review your codes and modify your practices as necessary.
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