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Medical Technology Assessment Committee Approval  – May 1, 2014
National Medical Care Management Committee Approval – May 13. 2014
Provider Advisory Committee Approval – September 8, 2014
Quality Management Oversight Committee Approval – October 10, 2014


To view a Summary of Previous Changes or for a printable version of the table below, please click here (PDF 207.19 KB).

Topic

Guideline

Acute Myocardial Infarction with ST Elevation

2013 ACC/AHA Guidelines for the Management of ST-Elevation Myocardial Infarction

American College of Cardiology/American Heart Association

http://circ.ahajournals.org/content/127/4/e362.full.pdf

Acute Myocardial Infarction without ST Elevation

 

2012 Focused Update: ACC/AHA Guidelines for the Management of Patients with Unstable Angina/Non–ST- Elevation Myocardial Infarction (Updating the 2007 Guideline).

American College of Cardiology/American Heart Association

http://circ.ahajournals.org/content/127/23/e663.full.pdf

Asthma

2007 National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines for the Diagnosis and  Management of Asthma

National Heart, Lung and Blood Institute

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

American Academy of Child and Adolescent Psychiatry

http://download.journals.elsevierhealth.com/pdfs/journals/0890-8567/PIIS0890856709621821.pdf

Autism Spectrum Disorders

UHC Utilization Review Guidelines – Autism Spectrum Disorders

Internal (Knowledge Library):

http://kl/Content/Guidelines%20&%20Clinical%20Policies/Utilization%20Review%20Guidelines/Internal%20and%20External/Autism%20Spectrum%20Disorder_URG.doc

 

External (UnitedHealthcareOnline.com):

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Autism_Spectrum_Disorder_URG.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)

·         Bariatric Conversion Procedures

Bipolar Disorder: Adults

Guideline Watch (November 2005): Practice Guideline for the Treatment of Patients with Bipolar Disorder, 2nd Edition

American Psychiatric Association

http://psychiatryonline.org/data/Books/prac/Bipolar.watch.pdf

Bipolar Disorder: Children &  Adolescents

2007 Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder

American Academy of Child and Adolescent Psychiatry

http://download.journals.elsevierhealth.com/pdfs/journals/0890-8567/PIIS0890856709619687.pdf

Cardiology: CareCore Advanced Imaging Guidelines - Commercial

 

Physician Guidelines: Current Evidence-Based Recommendations Regarding Cardiology

Internal (Knowledge Library):

http://kl/Upload/wazeve1/UnitedHealthCare_Commercial_Cardiology_Criteria_2014.pdf

 

External (UnitedHealthcareOnline.com):

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Clinician%20Resources/Cardiology/UnitedHealthCare_Commercial_Cardiology_Criteria.pdf

 

Cardiology: CareCore Advanced Imaging Guidelines - Medicare

 

UnitedHealthcare Medicare Solutions: Evidence-Based Clinical Guidelines – Cardiology

Internal (Knowledge Library):

http://kl/Upload/wazeve1/Medicare_Advantage_Cardiology_Prior_Authorization_Program_Clinical_Criteria_2014.pdf

 

External (UnitedHealthcareOnline.com):

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Clinician%20Resources/Cardiac/Medicare_Advantage_Cardiology_Prior_Authorization_Program_Clinical_Criteria.pdf

 

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

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

American College of Cardiology/American Heart Association

http://circ.ahajournals.org/content/124/22/2458.full.pdf

 

Cervical Cancer Screening

ACOG Practice Bulletin #131

Screening for Cervical Cancer

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

 

The National Guideline Clearinghouse provides a synopsis of the guideline at http://www.guideline.gov/content.aspx?id=38572

 

Chemotherapy Observation or Inpatient Hospitalization

UHC Utilization Review Guidelines – Chemotherapy Observation or Inpatient Hospitalization

Internal (Knowledge Library):

http://kl/Content/Guidelines%20&%20Clinical%20Policies/Utilization%20Review%20Guidelines/Internal%20and%20External/Chemo%20URG.doc

 

External (UnitedHealthcareOnline.com):

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

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults  

American College of Cardiology/American Heart Association

https://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437738.63853.7a.full.pdf

 

Chronic Obstructive Lung Disease (COPD)

Global Strategy for Diagnosis, Management and Prevention of COPD – 2014

Global Initiative for Chronic Obstructive Lung Disease (GOLD)

http://www.goldcopd.org/uploads/users/files/GOLD_Report2014_Feb07.pdf

 

Depression/ Major Depressive Disorder

 

Practice Guideline For The Treatment of Patients With Major Depressive Disorder, Third Edition

American Psychiatric Association

http://psychiatryonline.org/pdfaccess.ashx?ResourceID=243261&PDFSource=6

 

Diabetes

Standards of Medical Care in Diabetes – 2014

American Diabetes Association

http://care.diabetesjournals.org/content/37/Supplement_1/S14.full.pdf+html

Dietary Guidelines

Dietary Guidelines for Americans, 2010

U.S. Department of Health and Human Services

http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf

Heart Failure

2013 ACCF/AHA Guideline for the Management of Heart Failure

American College of Cardiology/American Heart Association

http://circ.ahajournals.org/content/128/16/e240.full.pdf

 

Hemophilia and von Willebrand Disease

Guidelines for the Management of Hemophilia, 2nd edition

World Federation of Hemophilia

http://www1.wfh.org/publication/files/pdf-1472.pdf

 

The Diagnosis, Management and Treatment of von Willebrand Disease: 2007 NHLBI Guidelines

National Heart, Lung & Blood Institute

http://www.nhlbi.nih.gov/guidelines/vwd/vwd.pdf

 

Human Immuno-deficiency Virus (HIV)

 

 

Primary Care Guidelines for the Management of Persons Infected with HIV: 2013 Update

HIV Medicine Association of  the Infectious Diseases Society of America

http://cid.oxfordjournals.org/content/58/1/1.full.pdf

 

Hyperbilirubinemia in Newborns

American Academy of Pediatrics Clinical Practice Guideline (2004): Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation

American Academy of Pediatrics

http://pediatrics.aappublications.org/content/114/1/297.full.pdf

 

American Academy of Pediatrics (2009): Hyperbilirubinemia in the Newborn Infant ≥35 Weeks’ Gestation: An Update with Clarifications

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

 

Hypertension

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)

Panel Members Appointed to the Eighth Joint National Committee (JNC 8)

http://jama.jamanetwork.com/data/Journals/JAMA/929741/jsc130010.pdf

 

Infertility

·         Infertility Clinical Performance and Medical Necessity Guidelines

·         Elective Single Embryo Transfer (eSET)

·         Infertility Surgery

Inpatient Pediatric Feeding Programs

UHC Utilization Review Guidelines – Inpatient Pediatric Feeding Programs

Internal (Knowledge Library):

http://kl/Content/Guidelines%20&%20Clinical%20Policies/Utilization%20Review%20Guidelines/Internal%20and%20External/Inpatient%20Pediatric%20Feeding%20Programs_URG.doc

 

External (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)

·         Maternal Cardiovascular Disorders Associated with Pregnancy

·         Neurologic Disorders in Pregnancy

·         Skin and Pregnancy

·         Intimate Partner Violence

·         Hemolytic Disease of the Fetus and Newborn

·         Endocrine Disorders in Pregnancy

·         Assessment and Induction of Fetal Pulmonary Maturity

·         17P, Vaginal Progesterone, Cerclage and Preterm Birth

·         Methodology for Lowering C-Section Rates

Mechanical Circulatory Support (including Ventricular Assist Devices)

Mechanical Circulatory Support Devices Clinical Guideline

MCG™ Care Guidelines

MCG™ Care Guidelines, 18th Edition

MCG™ Care Guidelines

http://www.careguidelines.com

 

Neonatal Resource Services Clinical Guidelines

·         Apnea and Bradycardia

·         Discharge Planning

·         Feeding the Neonate

·         Inhaled Nitric Oxide

·         Early-Onset Neonatal Sepsis

·         Thermoregulation

Obesity

American Academy of Pediatrics (AAP) Obesity Portal

American Academy of Pediatrics Institute for Healthy Childhood Weight

http://ihcw.aap.org/Pages/default.aspx

 

The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults, October 2000

National Heart, Lung and Blood Institute

http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf

 

Oncology

 

National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology

National Comprehensive Cancer Network

http://www.nccn.org

Organ Transplantation

 

2013 Transplant Review Guidelines: Solid Organ and Stem Cell Transplantation

Internal (Knowledge Library):

http://kl/Upload/wazeve1/2013_Transplant_Review_Guidelines.pdf

 

External (UnitedHealthcareOnline.com):

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Clinical%20Guidelines/2013_Transplant_Review_Guidelines.pdf

Perinatal Care

 

 

 

 

 

 

Guidelines for Perinatal Care, 7th edition 

American Academy of Pediatrics and 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

 

Alternatively, the book can be purchased from the American Academy of Pediatrics website.

http://ebooks.aap.org/product/guidelines-for-perinatal-care40442

To view a summary of the guidelines click here.

Physical Activity

2008 Physical Activity Guidelines for Americans

U.S. Department of Health and Human Services

http://www.health.gov/paguidelines/pdf/paguide.pdf

Preventive Pediatric Health Care Screening

2014 Recommendations for Pediatric Preventive Health Care

American Academy of Pediatrics

http://pediatrics.aappublications.org/content/133/3/568.full.pdf

Preventive Services

 

 

 

 

 

 

Guide to Clinical Preventive Services, 2012: Recommendations of the U.S. Preventive Services Task Force

Agency for Healthcare Research and Quality

http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/guide/guide-clinical-preventive-services.pdf

 

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.

Propranolol Treatment for Infantile Hemangioma

UHC Utilization Review Guidelines – Propranolol Treatment for Infantile Hemangiomas: Inpatient Protocol

Internal (Knowledge Library):

http://kl/Content/Guidelines%20&%20Clinical%20Policies/Utilization%20Review%20Guidelines/Internal%20and%20External/Propranolol_URG.doc

External (UnitedHealthcareOnline.com):

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Propranolol_URG.pdf

Radiology:

CareCore Advanced Imaging Guidelines Commercial and Medicaid

 

Physician Guidelines: Current Evidence-Based Recommendations Regarding Imaging - Commercial and Medicaid

Internal (Knowledge Library):

http://kl/Content/Guidelines%20&%20Clinical%20Policies/CareCore%20Physician%20Guidelines/Evidence-Based%20Clinical%20Guidelines%20for%20Imaging_2014_UHC%20Employer%20and%20Individual_pdf_Stub.htm

 

External (UnitedHealthcareOnline.com):

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Clinician%20Resources/Radiology%20Notification%20Program/Evidence_Based_Clinical_Guidelines_for_Imaging_2014.pdf

Radiology:

CareCore Advanced Imaging Guidelines Medicare and  Retirement

UnitedHealthcare Medical Solutions Evidence-Based Clinical Guidelines for Radiology - Medicare and Retirement

Internal (Knowledge Library):

http://kl/Content/Guidelines%20&%20Clinical%20Policies/CareCore%20Physician%20Guidelines/Evidence-Based%20Clinical%20Guidelines%20for%20Imaging_2014_UHC%20Medicare_Retirement_pdf_Stub.htm

 

External (UnitedHealthcareOnline.com):

https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Clinician%20Resources/Radiology%20Notification%20Program/2014_Medicare_Advantage_Evidence_Based_Clinical_Guidelines_Imaging.pdf

Schizophrenia

Guideline Watch (September 2009): Practice Guideline for the Treatment of Patients with Schizophrenia

American Psychiatric Association/ PsychiatryOnline Guideline Watch

http://psychiatryonline.org/pdfaccess.ashx?ResourceID=243181&PDFSource=6

Sickle Cell Disease

The Management of Sickle Cell Disease, 4th Edition National Heart, Lung, and Blood Institute (NHLBI)

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

North American Spine Society

https://www.spine.org/Documents/ResearchClinicalCare/Guidelines/LumbarStenosis.pdf

Stable Ischemic Heart Disease

2012 Guideline for the Diagnosis and Management of Patients with Stable Ischemic Heart Disease

American College of Cardiology/American Heart Association et al.

http://circ.ahajournals.org/content/126/25/e354.full.pdf+html

Substance Use Disorders

Guideline Watch (April 2007): Practice Guideline for the Treatment of Patients with Substance Use Disorders

American Psychiatric Association/ PsychiatryOnline Guideline Watch

http://focus.psychiatryonline.org/data/Journals/FOCUS/2693/foc00207000163.pdf

Tobacco Use

Treating Tobacco Use and Dependence: 2008 Update

U.S. Department of Health and Human Services

http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/treating_tobacco_use08.pdf

 

Supplement: Corrections and Additions to the 2008 Guideline Update

http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/clinicians/update/correctadd.html