Community Plan Medical & Drug Policies and Coverage Determination Guidelines

The Medical Policies, Medical Benefit Drug Policies, Coverage Determination Guidelines, Utilization Review Guidelines and corresponding update bulletins for UnitedHealthcare Community Plan are listed below.

Open the section below to view more information.

A monthly notice of recently approved and/or revised Medical Policies, Medical Benefit Drug Policies, Coverage Determination Guidelines (CDGs), and Utilization Review Guidelines (URGs) is provided below for your review. We publish a new announcement on the first calendar day of every month.

The appearance of a health service (e.g., test, drug, device or procedure) in the Medical Policy Update Bulletin does not imply that UnitedHealthcare provides coverage for the health service. In the event of an inconsistency or conflict between the information provided in the Medical Policy Update Bulletin and the posted policy, the provisions of the posted policy will prevail.

For Kentucky, click here to view the Medical Policy Update Bulletins.

Current Policies & Guidelines

This Community Plan medical policy library does not apply to the following states; click the link to view the applicable Medical & Drug Policies and Coverage Determination Guidelines:

  • For Indiana, click here.
  • For Kentucky, click here.
  • For Louisiana, click here.
  • For Tennessee, click here.

For Louisiana, click here to view MCG criteria for the top Outpatient procedures and Admission diagnoses.

To submit new or additional clinical evidence pertaining to a specific medical policy, click here to complete a form for UnitedHealthcare Medical Policy review. Do not submit protected health information using this form. If you have questions or concerns about a specific service for a member, refer to the appropriate Benefits, Claims, or Prior Authorization/Notification process.