Chemotherapy Observation or Inpatient Hospitalization – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers inpatient hospitalization or observation for adults (≥18) when chemotherapy regimens or complications require inpatient monitoring or complex multi‑day administration (e.g., EPOCH/DA‑EPOCH/R‑EPOCH, ESHAP/R‑ESHAP, IL‑2, high‑dose ifosfamide, high‑dose methotrexate with leucovorin rescue, Hyper‑CVAD, TACE/intra‑arterial infusions, acute leukemia, prophylaxis for tumor lysis) and excludes individuals under 18 and routine outpatient/home/office administration. Coverage requires a written treatment protocol and specific monitoring/documentation (e.g., serum methotrexate levels, continuous cardiac monitoring, electrolyte/urine pH checks, procedure notes), uses InterQual® criteria for unlisted situations, and any inpatient‑stay extensions require clinical review and are subject to member‑specific benefit limits.

"Note: This policy does not apply to individuals under 18 years of age."