Why UHC Denies Epidural Steroid Injection
Exceeds frequency limit (usually 3 per year per region)
Conservative therapy not documented
Prior injection did not provide documented relief
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 radicular symptoms correlating with imaging
Note percentage and duration of relief from prior injection
Show failure of oral medications and PT
Reference imaging confirming nerve compression at the targeted level
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
- ASIPP Guidelines for Interventional Pain Management
- NASS Coverage Recommendations for ESI
Relevant CPT Codes
Specialty: Pain Management / Anesthesiology
Want the full strategy?
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