Provider Administered Drugs – Site of Care – Commercial Medical Benefit Drug Policyopen_in_new

UnitedHealthcare covers hospital outpatient facility infusion (place-of-service 19 and 22) for provider‑administered specialty medications and IVIG/SCIG only when the member meets at least one specified high‑risk criterion (e.g., medical instability requiring hospital‑only equipment, prior severe infusion reactions unresponsive to standard measures, inability to tolerate IV fluid load, IgA deficiency with anti‑IgA, severe vascular access issues, initial/re‑initiation after >6 months, or lack of safe home/office/ambulatory options). Coverage requires submission of supporting medical records documenting the specific criterion, is generally limited to a maximum 6‑month authorization (durations vary by criterion), excludes facility administration if criteria are not met (alternative sites expected), and is subject to the member’s benefit plan and any applicable drug‑specific policies.

"Authorization of hospital outpatient facility infusion services (place of service codes 19 and 22) for specialty medications and IVIG/SCIG when outpatient hospital facility-based administration is ..."