COVERAGE POLICY UPDATES
Medical Policy Updates
University of Utah Health Plans uses medical policies as guidelines for coverage determinations in accordance with the member’s benefits. Quarterly notice of recently approved and revised medical policies is provided in Provider Connection for your convenience. The Medical Policy Updates section of this newsletter does not indicate that coverage is provided for the procedures listed.
| NEW POLICIES | |||
|---|---|---|---|
| Policy Number | Policy Name | Effective Date | Summary |
| ADMIN-010 (New) | Telehealth Policy | 06/30/2025 | Commercial Plan: U of U Health Plans covers telehealth video visits, including primary care, specialty care, behavioral health and urgent care visits and via selected vendor solutions. Please see the policy for further details. |
| MP-045 (New) | Ketamine-Assisted Psychotherapy (KAP) | 04/26/2025 | Commercial Plan: U of U Health Plans covers a one-time consultation with a psychiatrist, APRN, or PA to assess eligibility for Ketamine-Assisted Psychotherapy (KAP). Please see the policy for further details. |
| MP-082 (New) | Cardiac Fludeoxyglucose-Positron Emission Tomography (FDG-PET) Scans | 07/28/2025 | Commercial Plan: U of U Health Plans considers cardiac fludeoxyglucose-positron emission tomography (FDG-PET) scanning medically necessary to assess myocardial perfusion and thus diagnose coronary artery disease in individuals with indeterminate single photon emission computed tomography (SPECT) scan. Please see the policy for further details. |
| REVISED POLICIES | |||
|---|---|---|---|
| Policy Number | Policy Name | Effective Date | Summary |
| MP-005 (Revised) | Balloon Dilation of the Eustachian Tube | 05/19/2025 | Commercial Plan: U of U Health Plans revised the following criteria for balloon dilation of the eustachian tube: age to 12 years old instead of 18 years or older; the presence of symptoms to three or six months instead of 12 months; require nasal cavity inspection and neck exam in addition to present exam requirements; add contraindications for neuromuscular disorders (e.g., MS, Myasthenia gravis, ALS etc.). Please see the policy for further details. |
| MP-041 (Revised) | Bone Mineral Density Studies | 06/16/2025 | Commercial Plan: The policy did not address pediatric DXA scans as a diagnostic tool for low bone mineral mass or density in children. Therefore, criteria was added, along with updated description, rationale and references. Please see the policy for further details. |
| MP-012 (Revised) | Formulas and Other Enteral Nutrition | 07/28/2025 | Commercial Plan: Revisions included updating the Cystic Fibrosis (CF) portion of the policy, removing redundant language and combining Medical Necessity criteria under General Coverage Requirements for less confusion. Please see the policy for further details. |