UnitedHealthcare Community Plan
You appear to be browsing this site using Internet Explorer 6. This browser is now out of date. For safer, more reliable browsing it is recommended that you upgrade your browser to Firefox, Safari or Internet Explorer 7 or 8.
Shortcut Navigation:
Please select the state where you practice.

 

Medical Technology Assessment Committee Approval Status – May 2013
National Medical Care Management Committee Approval Status – June 2013
National Quality Management Oversight Committee Approval – July 2013

To view a Summary of Previous Changes or for a printable version of the table below, please click here (PDF 468.21 KB).

 Topic

Guideline

 

Acute Myocardial Infarction (MI)
with ST Elevation


2009 Focused Updates: Acc/AHA Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update)
Source: American College of Cardiology/AHA: http://circ.ahajournals.org/content/120/22/2271.full.pdf

Acute Myocardial Infarction without ST Elevation 2011 Focused Update: ACC/AHA Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction (Updating the 2007 Guideline).
Source: American College of Cardiology/AHA: http://circ.ahajournals.org/content/123/18/e426.full.pdf+html

Asthma 2007 National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines for the Diagnosis and  Management of Asthma.
Source: National Heart, Lung and Blood Institute: http://www.nhlbi.nih.gov/guidelines/asthma/index.htm

Attention Deficit Hyperactivity Disorder (ADHD) 2007 Practice Parameter for the Assessment and Treatment of Children and Adolescents with Attention Deficit Hyperactivity Disorder.
Source: American Academy of Child and Adolescent Psychiatry:
http://dss.mo.gov/mhd/cs/psych/pdf/jaacap_adhd2007.pdf

Bariatric Surgery Bariatric Resource Service Clinical Job Aids:
• Laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD- DS)
• Laparoscopic Roux-en-Y Gastric Bypass Procedure (LRYGBP)  
• Laparoscopic Sleeve Gastrectomy (LSG)
• Laparoscopic Adjustable Gastric Banding (LAGB)

 

Bipolar Disorder: Adults

 

Guideline Watch (November 2005): Practice Guideline for the Treatment of Patients with Bipolar Disorder, 2nd Edition.
Source: American Psychiatric Association:
http://psychiatryonline.org/data/Books/prac/Bipolar.watch.pdf

 

Bipolar Disorder: Children &  Adolescents

 

Guideline Watch (November 2005): Practice Guideline for the Treatment of Patients with Bipolar Disorder, 2nd Edition
Source: American Psychiatric Association:
http://psychiatryonline.org/data/Books/prac/Bipolar.watch.pdf

 

Cardiology: CareCore ENM Guidelines


Physician Guidelines: Current Evidence-Based Recommendations Regarding Cardiology (2012).

 

Cardiovascular Disease: Prevention in Women


Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women 2011 Update:  A Guideline from the American Heart Association.
Source: American Heart Association:
http://circ.ahajournals.org/content/123/11/1243.full.pdf


Cardiovascular Disease: Secondary Prevention
and Risk
Reduction Therapy for Patients
with Coronary
and Other Atherosclerotic Vascular Disease

 



2011 AHA/ACC Guidelines for Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and Other Atherosclerotic Vascular Disease.
Source: American College of Cardiology/American Heart Association:
http://circ.ahajournals.org/content/124/22/2458.full




Cervical Cancer
Screening
 


ACOG Practice Bulletin #109. Cervical Cytology Screening.
Source: American College of Obstetricians and Gynecologists.
Note: This guideline is not publically available; a user ID and password are required to access the document via:  
http://www.acog.org/Resources_And_Publications

 

Chemotherapy Observation or Inpatient Hospitalization

 

UHC Utilization Review Guidelines – Chemotherapy Observation or Inpatient Hospitalization.
Source: https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Chemotherapy_Observ_and_Inpatient_Hosp_URG.pdf

Cholesterol Management

 


2004 Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults(Adult Treatment Panel III).
Source: National Heart, Lung and Blood Institute:
http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm


Chronic Obstructive Lung Disease
 

2011 Global Initiative for Chronic Obstructive Lung Disease.
Source: Global Initiative for Chronic Obstructive Lung Disease (GOLD)
http://www.goldcopd.org

 

Chronic Stable Angina


2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients with Chronic Stable Angina.
Source: American College of Cardiology/AHA:
http://circ.ahajournals.org/content/116/23/2762.full

 

Depression/Major Depressive Disorder


Practice Guideline For The Treatment of Patients With Major Depressive Disorder, Third Edition.
Source: American Psychiatric Association:
http://psychiatryonline.org/guidelines.aspx

 
Diabetes
 

Standards of Medical Care in Diabetes - 2012.
Source: American Diabetes Association:
http://care.diabetesjournals.org/content/35/Supplement_1/S11.full.pdf+html

External Insulin Infusion Pump
During Pregnancy
Healthy First Step: External Insulin Subcutaneous Infusion Pump for Diabetes in Pregnancy.
Source: Community and State Medical Necessity Prior Authorization Criteria Job Aid.

 
Heart Failure
2009 Focused Update Incorporated Into the ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Heart Failure in Adults.
Source: American College of Cardiology/American Heart Association:
http://circ.ahajournals.org/content/119/14/e391.full.pdf


Hemophilia
and
von Willebrand Disease
 

Guidelines for the Management of Hemophilia.
Source: World Federation of Hemophilia:
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2516.2012.02909.x/pdf



The Diagnosis, Management and Treatment of von Willebrand Disease: 2007 NHLBI Guidelines.
Source: National Heart, Lung & Blood Institute:
http://www.nhlbi.nih.gov/guidelines/vwd/index.htm.

 


Human Immuno-deficiency Virus (HIV)

 

Primary Care Guidelines for the Management of Persons Infected with Human Immunodeficiency Virus: 2009 Update by the HIV Medicine Association of  the Infectious Diseases Society of America.
Source: HIV Medicine Association of  the Infectious Diseases Society of America: http://www.journals.uchicago.edu/doi/pdf/10.1086/605292



Hyperbili-rubinemia in Newborns
 

American Academy of Pediatrics:
http://pediatrics.aappublications.org/content/114/1/297.full.pdf  

http://pediatrics.aappublications.org/content/124/4/1193.full.pdf

 

 Hypertension The Seventh Report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (2004).
Source: National Heart, Lung and Blood Institute:
http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf

 Infertility • Fertility Preservation Clinical Guidelines
• ICSI Clinical Guidelines
• Natural Cycle Clinical Guidelines
• Ovarian Stimulation Clinical Guideline
• PCOS Clinical Guidelines
• Single Embryo Transfer Clinical Guidelines
• Standard Infertility Workup Clinical Guidelines
• Treatment of Unexplained Infertility Clinical Guidelines



Inpatient Pediatric Feeding Programs
UHC Utilization Review Guidelines – Inpatient Pediatric Feeding Programs.
Source: (UnitedHealthcareOnline.com):
https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Inpatient%20Pediatric%20Feeding%20Programs_URG.pdf

 

Maternal Support Program Clinical Guidelines

• Anemia and Pregnancy Clinical Guidelines
• Cervical Insufficiency Clinical Guidelines
• Avoidance of Elective Deliveries before 39 Weeks Gestation
• Assessment of Fetal Well Being
• Administration of 17P for Prevention of Preterm Birth
• Breast Milk Feeding
• Coagulation Disorders in Pregnancy
• Gastrointestinal Disease in Pregnancy
• Gestational Diabetes
• Intrauterine Growth Restriction (IUGR)
• Malignancy and Pregnancy
• Maternal and Fetal Infections
• Maternal Nutrition and Obesity
• Multiple Gestation
• Placenta Previa
• Diseases of the Liver Biliary System and Pancreas in Pregnancy
• Post-Term Pregnancy
• Pregnancy Related Hypertension
• Premature Rupture of Membranes (PROM)
• Preterm Labor and Birth
• Respiratory Disease in Pregnancy
• Thromboembolic Disease in Pregnancy
• Thyroid Disease in Pregnancy
• Trial of Labor after C-Section (TOLAC) and Vaginal Birth after C-Section (VBAC)

Milliman Care Guidelines Milliman Care Guidelines®,  17th Edition.
Source: Milliman Care Guidelines:
http://www.careguidelines.com
 

Oncology
 

National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in OncologY.
Source: National Comprehensive Cancer Network: http://www.nccn.org/index.asp

 

Organ Transplantation (Optum Health)

UHC 2011Transplant Review Guidelines: Solid Organ and Stem Cell Transplantation.
Source: (UnitedHealthcareOnline.com):
https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Clinical%20Guidelines/Transplant_Review_Guidelines.pdf

Perinatal Care

American Academy of Pediatrics and The American College of Obstetricians and Gynecologists, Sixth Edition, Guidelines for Perinatal Care.
Source: American College of Obstetricians and Gynecologists
Note: This resource is not publically available; a user ID and password are required to access the document via: 
http://www.acog.org/Resources_And_Publications

Preventive Pediatric Health Care Screening 2009 Recommendations for Preventive Pediatric Health Care:  American Academy of Pediatrics Screening Guidelines (periodicity schedule).
Source: American Academy of Pediatrics:
http://brightfutures.aap.org/pdfs/AAP%20Bright%20Futures%20Periodicity%20Sched%20101107.pdf

Preventive Services

Guide to Clinical Preventive Services, 2010-2011: Recommendations of the U.S. Preventive Services Task Force

Note: Although the USPSTF concluded that the current evidence is insufficient to assess the additional benefits and harms of digital mammography instead of film as a screening modality for breast cancer, before the age of 50, UnitedHealthcare will cover this as a preventive health service.

Source: Agency for Healthcare Research and Quality: http://www.ahrq.gov/clinic/pocketgd.htm


Radiology:
CareCore
EBM Guidelines

Physician Guidelines: Current Evidence-Based Recommendations Regarding Imaging (2012).
Source: (Unitedhealthcareonline.com):
https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Clinician%20Resources/Radiology%20Notification%20Program/Evidence_Based_Clinical_Guidelines-Imaging_2012.pdf

Schizophrenia Guideline Watch (September 2009): Practice Guideline for the Treatment of Patients with Schizophrenia.
Source: American Psychiatric Association/ PsychiatryOnline Guideline Watch:
http://psychiatryonline.org/content.aspx?bookid=28&sectionid=1682213#501001


Sickle Cell
Disease
The Management of Sickle Cell Disease, 4th Edition National Heart, Lung, and Blood Institute (NHLBI).
Source: National Heart, Lung and Blood Institute:
http://www.nhlbi.nih.gov/health/prof/blood/sickle/sc_mngt.pdf

Spinal Stenosis 2011 Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care
Diagnosis and Treatment of Degenerative Lumbar Spinal Stenosis.
Source: North American Spine Society:
http://www.spine.org/Documents/LumbarStenosis11.pdf

Substance Use Disorders Guideline Watch (April 2007): Practice Guideline for the Treatment of Patients with Substance Use Disorders.
Source: American Psychiatric Association/ PsychiatryOnline Guideline Watch: http://focus.psychiatryonline.org/article.aspx?articleid=52296