Private Duty Nursing Services – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers private duty nursing only when it meets the policy’s Skilled Care definition (skilled nursing, teaching, habilitation or rehabilitation requiring licensed personnel and not custodial) and when allowed by the member’s specific benefit plan; custodial and routine non‑skilled services (e.g., ADL assistance, routine meds, basic catheter/ostomy maintenance, noninfected dressing changes, etc.) are excluded. Coverage requires a CMS‑485 Home Health Certification with a physician (MD/DO) or authorized advanced practitioner (NP, CNS, PA) signature, may require additional medical records, and the number of PDN hours is determined using the InterQual LOC: Home Care PDN Assessment.

"Private duty nursing services with Skilled Care are covered in certain circumstances."

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