Why UHC Denies Knee Arthroscopy
Degenerative meniscal tear in patient over 40
Conservative therapy not exhausted
Imaging does not support mechanical symptoms
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 mechanical symptoms (locking, catching, giving way)
Distinguish traumatic from degenerative tear
Note failure of 3+ months conservative management
Reference MRI findings showing displaced meniscal fragment
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
- AAOS Clinical Practice Guidelines for Knee Arthroscopy
- AIM Specialty Health MSK Guidelines
Relevant CPT Codes
Specialty: Orthopedics
Want the full strategy?
The P2P Playbook covers payer-specific approaches for Knee Arthroscopy 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.
Get The P2P Playbook -- $39Get a personalized P2P script in 60 seconds
Enter your specific case details and our AI generates a structured prep script tailored to UHC's criteria.