UnitedHealthcare Commercial and Exchange Plans Cardiovascular and Radiology Clinical Guidelines - Effective November 18, 2025

UnitedHealthcare covers medically necessary imaging for diagnosing cardiovascular conditions and for patient assessments, provided that clinical evaluations are supported by detailed history, physical examination, and laboratory studies. Key requirements include obtaining prior authorization for non-emergency procedures and ensuring that services meet medical necessity criteria per state Medicaid policy. Limitations include the exclusion of screening imaging without symptoms, restrictions on repeat imaging within six months unless justified, and potential non-coverage if alternative guidelines are followed or state policies do not address the member's condition.

"Imaging is covered for diagnosing cardiovascular conditions based on clinical guidelines."

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