Surgery of the Ankle – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers ankle surgeries (arthrodesis, arthroscopy, arthrotomy, and total ankle replacement) as medically necessary only when the member meets the cited InterQual® clinical criteria, while osteochondral allograft/autograft (OCA/OAT) for ankle cartilage defects is considered unproven and not medically necessary. Coverage requires documentation demonstrating InterQual® criteria and the member-specific benefit plan are met (meeting criteria does not guarantee payment), and Medicare Advantage claims follow applicable NCD/LCD rules.

"Surgery of the ankle (including arthrodesis, arthroscopy, arthrotomy, and total joint replacement of the ankle) when medically necessary and when the member meets the applicable clinical coverage c..."

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