Why UHC Denies CT Abdomen and Pelvis
Prior imaging not performed first (ultrasound, X-ray)
Diagnosis does not support advanced imaging
Duplicate study within short timeframe
Know UnitedHealthcare's Criteria
UHC uses InterQual criteria and their own Clinical UM Guidelines (CG series). Medical directors are typically accessible for P2P within 5 business days.
Key policies to know:
- Requires eviCore for MSK and advanced imaging prior auth
- Clinical UM Guidelines (CG series) are publicly available online
- Prior auth through Optum/UHG portal
- Known for strict step therapy requirements on biologics
Building Your Medical Necessity Argument
Document why less invasive imaging is insufficient
Note acute clinical findings requiring CT
Reference abnormal lab values or physical exam findings
Cite clinical suspicion for specific pathology (abscess, mass, obstruction)
P2P Call Tips for UHC
Reference UHC's own Clinical UM Guideline number (e.g., CG-SURG-71)
UHC medical directors respond well to InterQual criteria language
Be specific about which InterQual subset applies
Have the CG policy number ready -- shows you've done your homework
Guidelines to Reference
- ACR Appropriateness Criteria
- Choosing Wisely Recommendations for Abdominal Imaging
Relevant CPT Codes
Specialty: Internal Medicine / Emergency Medicine
Want the full strategy?
The P2P Playbook covers payer-specific approaches for CT Abdomen and Pelvis denied by UHC -- plus 15 denial objections with word-for-word responses, what reviewers are actually thinking, and the 60-second prep framework. Written by a medical director who reviewed cases for major payers.
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