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CCA Health Medical Necessity Guidelines are used for requests for coverage of select medical and behavioral health services and supplies, select elective surgical procedures, pharmaceuticals, oral surgery, transplants, and other services. The guidelines are:

CCA Medical Necessity Guidelines

Active Water Circulation Pump with Cold Compression Pad

Acupuncture

Aduhelm™ (aducanumab-avwa)

Chimeric Antigen Receptor (CAR) T-Cell Therapy

Chiropractic Services

Clinical Trials, Routine Patient Care Costs

Complement Inhibitors – Eculizumab and Ravulizumab-cwvz

Continuous Glucose Monitors (CGM)

Day Services

Determination and Documentation of Medical Necessity in an Inpatient Rehabilitation Facility

Excision of Excessive Skin & Subcutaneous Tissue

Experimental and Investigational Services

External Breast Prostheses

Gender Affirming Surgery and Related Procedures

Genetic Testing BRCA-Related Breast and/or Ovarian Cancer Syndrome

Genetic and Molecular Testing

Home Health Services – Medicare Advantage

Hospital Beds

Hyaluronic Acid Injection for Knee Osteoarthritis

Intravenous Iron Infusion

Leqembi (lecanemab-irmb)

Mattress – HCPC Coded Pressure Reducing Support Surfaces

Medical Necessity

Medicare Part B Step Therapy

New-to-Market Part B Medications

Non-Covered Benefit

Non-Preferred DME

Out of Network Coverage

Part B Drugs Requiring Prior Authorization

Power Seat Lift Chairs

Pulmonary Rehabilitation

Radiofrequency Ablation for Lung Cancer

Recommendations for Intermittent Skilled Therapy in a Nursing Facility (NF)

Recommendations for Skilled Nursing

Repairs and Modifications of Durable Medical Equipment (DME)

Rhinoplasty and Septoplasty

Skilled Nursing Facility (SNF) Services Under Medicare Part A

Skin and Soft Tissue Substitutes

Subacute Level of Care in a Skilled Nursing Facility (SNF) Under Medicare Part A