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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


Cardiac Rehabilitation

CG-Drug 95 Belatacept (Nulojix)

Chimeric Antigen Receptor (CAR) T-Cell Therapy

Chiropractic Services

Chore Services

Clinical Trials, Routine Patient Care Costs

Community Support Programs and Specialized Community Support Programs (CSP)

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

Gender Affirming Surgery and Related Procedures: CPT Codes

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

Genetic and Molecular Testing

Home Health Services – Medicare Advantage

Home Oxygen Therapy

Hospital Beds

Hyaluronic Acid Injection for Knee Osteoarthritis

Intravenous Iron Infusion

Mattress – HCPC Coded Pressure Reducing Support Surfaces

Medical Necessity

Medicare Part B Step Therapy

Medicare Part B Step Therapy Preferred Drug List

Modified T-Cell Therapy

New-to-Market Part B Medications

Non-Covered Benefit

Non-Preferred DME

Part B Drugs Requiring Prior Authorization

Pulmonary Rehabilitation

Radiofrequency Ablation for Lung Cancer

Recommendations for Intermittent Skilled Therapy in a SNF

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