Clinical Guidelines
UnitedHealthcare uses evidence-based clinical guidelines from nationally recognized sources during review of our quality and health management programs. Recommendations contained in clinical practice guidelines are not a guarantee of coverage. Members should consult their member-specific benefit plan document for information regarding covered benefits.
Allogeneic Processed Thymus Tissue-agdc (Rethymic®) – Clinical Guideline
Last Published 10.07.2024
This guideline addresses a treatment for congenital athymia, allogeneic processed thymus tissue (Rethymic®), and the circumstances under which it is considered medically necessary.
Asthma – Clinical Guideline
Last Published 06.27.2024
These guidelines outline the diagnosis and management of asthma.
Atrial Fibrillation – Clinical Guideline
Last Published 04.19.2024
This clinical guideline addresses recommendations for the optimum management of atrial fibrillation.
Behavioral Health – Clinical Guideline
Last Published 04.19.2024
This guideline outlines information regarding behavioral health.
Cancer – Clinical Guideline
Last Published 06.27.2024
These guidelines outline cancer treatment, detection, prevention, risk reduction, and supportive care.
Cardiovascular Disease: Primary Prevention – Clinical Guideline
Last Published 04.19.2024
This guideline addresses the primary prevention of cardiovascular disease in adults.
Chest Pain – Clinical Guideline
Last Published 04.19.2024
These guidelines outline the evaluation of acute or stable chest pain or other anginal equivalents, in various clinical settings, with an emphasis on the diagnosis on ischemic causes.
Chimeric Antigen Receptor T-Cell Therapy (for Ohio Only) – Clinical Guideline
Last Published 01.01.2025
This guideline outlines general information and indications for chimeric antigen T-cell therapy and provides links to relevant Ohio Administrative Code(s).
Chimeric Antigen Receptor T-Cell Therapy (for Ohio Only) – Clinical Guideline - Effective Mar. 1, 2025
Last Published 02.03.2025
Effective 03.01.2025 – This guideline outlines general information and indications for chimeric antigen T-cell therapy and provides links to relevant Ohio Administrative Code(s).
Chimeric Antigen Receptor T-Cell Therapy – Clinical Guideline
Last Published 01.15.2025
This guideline provides general information and indications for chimeric antigen T-cell receptor therapy.
Cholesterol Management – Clinical Guideline
Last Published 04.19.2024
This guideline outlines recommendations to address the practical management of individuals with high blood cholesterol and related disorders.
Chronic Coronary Disease – Clinical Guideline
Last Published 04.19.2024
This clinical guideline addresses the management of chronic coronary disease.
Chronic Obstructive Lung Disease (COPD) – Clinical Guideline
Last Published 04.19.2024
These practice parameters detail the assessment and treatment modalities for individuals with chronic obstructive lung disease.
Dementia – Clinical Guideline
Last Published 04.19.2024
This practice guideline contains general and specific treatment recommendations for patients with Alzheimer’s disease and other dementias.
Diabetes – Clinical Guideline
Last Published 04.19.2024
This clinical guideline outlines the care of the diabetic patient including screening, diagnosis, and treatment options.
Dietary Guidelines – Clinical Guideline
Last Published 04.19.2024
This guideline provides information and advice for choosing a healthy eating pattern that focuses on nutrient-dense foods and beverages and contributes to achieving and maintaining a healthy weight.
Fertility Solutions Medical Necessity Clinical Guideline: Infertility
Last Published 09.09.2024
This guideline provides an evidence-based approach to infertility management, infertility surgery, and the use of single embryo transfer in addition to describing the limitations of and recommendations for infertility treatment.
Gene Therapy – Clinical Guideline
Last Published 09.23.2024
This guideline contains general information, indications, and special considerations for the administration of ex vivo gene therapy.
Heart Failure – Clinical Guideline
Last Published 04.19.2024
This guideline outlines the stages of heart failure and describes a range of generally acceptable approaches for the diagnosis, management, and prevention of heart failure.
Hemophilia – Clinical Guideline
Last Published 04.19.2024
This guideline outlines the diagnosis, management, and treatment of hemophilia.
Human Immunodeficiency Virus (HIV) – Clinical Guideline
Last Published 04.19.2024
These guidelines outline the management of adults and adolescents infected with HIV.
Hypertension – Clinical Guideline
Last Published 04.19.2024
This clinical guideline addresses the prevention, detection, evaluation, and management of high blood pressure in adults.
Kidney Disease – Clinical Guideline
Last Published 04.19.2024
These guidelines provide evidence-based recommendations to aid clinicians in the treatment of particular diseases or groups of patients for all stages of chronic kidney disease (CKD) and related complications.
Mechanical Circulatory Support Devices (MCSD) – Clinical Guideline
Last Published 10.03.2024
This guideline outlines the indications, minimum evaluation requirements, contraindications, and special considerations for the use of long-term, durable mechanical circulatory support devices.
Medicare Chiropractic Services – Clinical Guideline
Last Published 11.20.2024
This policy provides the medical necessity criteria consistent with CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 30.5 for covered chiropractic services provided to Medicare Advantage members.
Medicare Outpatient Skilled Therapy PT OT ST – Clinical Guideline
Last Published 11.20.2024
This policy provides direction for the determination of medical necessity clinical coverage criteria for habilitation, rehabilitation, or maintenance therapies requiring the skills of a licensed physical, occupational, or speech therapist provided to Medicare Advantage members.
Obesity – Clinical Guideline
Last Published 04.19.2024
These guidelines outline interventions and practices for maintaining a healthy weight in children, adolescents, and adults.
Persons with Disabilities – Clinical Guideline
Last Published 04.19.2024
This guideline addresses psychological assessments and interventions for persons with disabilities.
Physical Activity – Clinical Guideline
Last Published 04.19.2024
This guideline provides information and guidance on the types and amounts of physical activity that provide substantial health benefits.
Preventive Pediatric Health Care Screening – Clinical Guideline
Last Published 04.19.2024
This guideline outlines the recommendations for preventive pediatric care from infancy to adolescence.
Preventive Services – Clinical Guideline
Last Published 04.19.2024
This guideline addresses a collection of evidence-based recommendations on clinical preventive services such as screenings, counseling services, and preventive medications.
Sepsis – Clinical Guideline
Last Published 04.19.2024
This guideline outlines the early management and resuscitation of patients with sepsis or septic shock and includes the definition of sepsis/septic shock.
Sickle Cell Disease – Clinical Guideline
Last Published 04.19.2024
These guidelines address the treatment of adult and pediatric sickle cell disease.
Special Health Care Needs – Clinical Guideline
Last Published 04.19.2024
This guideline defines the core components of a comprehensive, coordinated, and family-centered system of care for children and youth with special health care needs.
T-Cell Receptor T-Cell Therapy (for Ohio Only) – Clinical Guideline
Last Published 01.01.2025
This guideline outlines general information and indications for T-cell receptor T-cell therapy and provides links to relevant Ohio Administrative Code(s).
T-Cell Receptor T-Cell Therapy – Clinical Guideline
Last Published 10.07.2024
This guideline provides general information and indications for T-cell receptor T-cell therapy as a treatment of solid organ tumors.
Tobacco Use – Clinical Guideline
Last Published 04.19.2024
This guideline addresses the assessment of cigarette smoking and nicotine dependence, as well as behavioral, pharmacological, and supportive interventions that can be used in both inpatient and outpatient settings.
Transplant Review Guidelines: Hematopoietic Stem Cell Transplantation (for Ohio Only) – Clinical Guideline
Last Published 02.03.2025
This guideline outlines the general information, indications, contraindications, and special considerations for hematopoietic stem cell transplantation and provides links to relevant Ohio Administrative Code(s).
Transplant Review Guidelines: Hematopoietic Stem Cell Transplantation – Clinical Guideline
Last Published 01.14.2025
This guideline outlines the general information, indications, contraindications, and special considerations for hematopoietic stem cell transplantation.
Transplant Review Guidelines: Solid Organ Transplantation (for Ohio Only) – Clinical Guideline
Last Published 01.01.2025
This guideline outlines the general information, indications, contraindications, and special considerations for solid organ transplantation and provides links to relevant Ohio Administrative Code(s).
Transplant Review Guidelines: Solid Organ Transplantation – Clinical Guideline
Last Published 11.11.2024
This guideline outlines general information, indications, universal and organ-specific contraindications, and special considerations for solid organ transplantation.
Tumor-Infiltrating Lymphocyte (TIL) Cell Therapy – Clinical Guideline
Last Published 06.10.2024
This guideline provides general information and indications for tumor-infiltrating lymphocyte cell therapy (TIL).
Violence and Abuse – Clinical Guideline
Last Published 04.19.2024
This guideline address ethical principles of the medical profession and physicians’ responsibility in promoting the well-being of patients.
For questions, please contact your local Network Management representative or call the Provider Services number on the back of the member’s ID card.