Medicare Prior Authorization Medical Clinical Policies
Medical Clinical Policies
- CPG Grid Adopted Clinical Practice and Preventive Health Guidelines (PDF)
- MC.CP.MP.22 Stereotactic Body Radiation Therapy (PDF)
- MC.CP.MP.57 Lung Transplantation (PDF)
- MC.CP.MP.69 Intensity-Modulated Radiotherapy (PDF)
- MC.CP.MP.101 Donor Lymphocyte Infusion (PDF)
- MC.CP.MP.108 Allogeneic Hematopoietic Cell Transplants for Sickle Cell Anemia and Beta-thalassemia (PDF)
- MC.CP.MP.160 Wireless Pulmonary Artery Monitoring (PDF)
- MC.CP.MP.170 Peripheral Nerve Blocks (PDF)
- MC.CP.MP.182 Short Inpatient Stay (PDF)
- MC.CP.MP.246 Pediatric Kidney Transplantation (PDF)
- MC.CP.MP.248 Facility-based Sleep Studies for Obstructive Sleep Apnea (PDF)
Concert Genetics Policies
The Concert Genetics Clinical Criteria Support (PDF) document explains the evidence base for the Concert Genetics policies and the balance
of the benefits vs. the risks of the criteria.
- V2.2023 Concert Genetics Oncology Algorithmic Testing (PDF)
- V2.2023 Concert Genetics Genetic Testing Aortopathies and Connective Tissue Disorders (PDF)
- V2.2023 Concert Genetics Genetic Testing Cardiac Disorders (PDF)
- V2.2023 Concert Genetics Oncology Cancer Screening (PDF)
- V2.2023 Concert Genetics Oncology Circulating Tumor DNA and Circulating Tumor Cells Liquid Biopsy (PDF)
- V2.2023 Concert Genetics Oncology Cytogenetic Testing (PDF)
- V2.2023 Concert Genetics Genetic Testing Dermatologic Conditions (PDF)
- V2.2023 Concert Genetics Genetic Testing Epilepsy, Neurodegenerative, and Neuromuscular Conditions (PDF)
- V2.2023 Concert Genetics Genetic Testing Exome and Genome Sequencing for the Diagnosis of Genetic Disorders (PDF)
- V2.2023 Concert Genetics Genetic Testing Eye Disorders (PDF)
- V2.2023 Concert Genetics Genetic Testing Gastroenterologic Disorders (non-cancerous) (PDF)
- V2.2023 Concert Genetics Genetic Testing General Approach to Genetic Testing (PDF)
- V2.2023 Concert Genetics Genetic Testing Hearing Loss (PDF)
- V2.2023 Concert Genetics Genetic Testing Hematologic Condition (non-cancerous) (PDF)
- V2.2023 Concert Genetics Genetic Testing Hereditary Cancer Susceptibility (PDF)
- V2.2023 Concert Genetics Genetic Testing Immune, Autoimmune, and Rheumatoid Disorders (PDF)
- V2.2023 Concert Genetics Genetic Testing Kidney Disorders (PDF)
- V2.2023 Concert Genetics Genetic Testing Lung Disorders (PDF)
- V2.2023 Concert Genetics Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies (PDF)
- V2.2023 Concert Genetics Genetic Testing Metabolic, Endocrine, and Mitochondrial Disorders (PDF)
- V2.2023 Concert Genetics Genetic Testing Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay (PDF)
- V2.2023 Concert Genetics Genetic Testing Non-Invasive Prenatal Screening (NIPS) (PDF)
- V2.2023 Concert Genetics Genetic Testing Pharmacogenetics (PDF)
- V2.2023 Concert Genetics Genetic Testing Preimplantation Genetic Testing (PDF)
- V2.2023 Concert Genetics Genetic Testing Prenatal and Preconception Carrier Screening (PDF)
- V2.2023 Concert Genetics Genetic Testing Prenatal Diagnosis via Amniocentesis, CVS or PUBS and Pregnancy Loss (PDF)
- V2.2023 Concert Genetics Genetic Testing Skeletal Dysplasia and Rare Bone Disorders (PDF)
New Century Health Cardiology Policies
New Century Health cardiology policies are applicable to the following Wellcare Medicare plans as of the dates noted below:
- July 1, 2023: CT, FL, HI, KY, LA, MA, MI, NC, RI, VT, NH, OH, GA, MO, TX, and WA
- October 1, 2023: AL, MS, NJ, SC, IL, and TN