Medicaid: New vascular embolization policy for KS, KY and NJ

To help support greater transparency and consistency in medical necessity review, we're aligning clinical criteria for select vascular procedures under one policy. Effective Dec. 1, 2026, we’ll implement a new vascular embolization policy and add prior authorization requirements for CPT® code 37242 for UnitedHealthcare Community Plans in Kansas, New Jersey and Kentucky.

Currently, services within the scope of the new policy may be evaluated under multiple existing medical policies. The new policy will outline the clinical criteria we’ll use to determine medical necessity when reviewing prior authorization requests for therapeutic vascular embolization procedures.

Coverage determinations will continue to be based on the member's benefit plan, applicable laws and the clinical criteria in the policy. As part of the review process, medical records may be requested to verify that the applicable clinical criteria have been met.

Resources 

• Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver – Community Plan Medical Policy
• Prostate Surgeries and Interventions – Community Plan Medical Policy
• Abnormal Uterine Bleeding and Uterine Fibroids – Community Plan Medical Policy