Medical Necessity Guidelines
Designed to facilitate consistent medical necessity determinations for coverage of select services and supplies.
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:
- Scientifically derived and evidence-based
- Developed or adopted with input and instructions from CCA Health physicians, specialty consultants, and actively practicing specialty physicians
- Developed in accordance with standards adopted by national accreditation organizations and regulatory and government entities
- Reviewed on an annual basis with input from appropriate actively practicing physicians and other providers
- Updated as new treatments, applications, and technologies are adopted as generally accepted professional medical practice
- Applied in a manner that considers the individual healthcare needs of the patient and characteristics of the local delivery system
- Evaluated at least annually for consistency with current policies for determination of coverage applied by the Utilization Review department at CCA Health
CCA Medical Necessity Guidelines
Active Water Circulation Pump with Cold Compression Pad
view:
Acupuncture
view:
Cardiac Rehabilitation
view:
CG-Drug 95 Belatacept (Nulojix)
view:
Chimeric Antigen Receptor (CAR) T-Cell Therapy
view:
Chiropractic Services
view:
Chore Services
view:
Clinical Trials, Routine Patient Care Costs
view:
Community Support Programs and Specialized Community Support Programs (CSP)
view:
Complement Inhibitors – Eculizumab and Ravulizumab-cwvz
view:
Continuous Glucose Monitors (CGM)
view:
Day Services
view:
Determination and Documentation of Medical Necessity in an Inpatient Rehabilitation Facility
view:
Excision of Excessive Skin & Subcutaneous Tissue
view:
Experimental and Investigational Services
view:
External Breast Prostheses
view:
Gender Affirming Surgery and Related Procedures
view:
Gender Affirming Surgery and Related Procedures: CPT Codes
view:
Genetic Testing BRCA-Related Breast and/or Ovarian Cancer Syndrome
view:
Genetic and Molecular Testing
view:
Home Health Services – Medicare Advantage
view:
Home Oxygen Therapy
view:
Hospital Beds
view:
Hyaluronic Acid Injection for Knee Osteoarthritis
view:
Intravenous Iron Infusion
view:
Mattress – HCPC Coded Pressure Reducing Support Surfaces
view:
Medical Necessity
view:
Medicare Part B Step Therapy
view:
Medicare Part B Step Therapy Preferred Drug List
view:
Modified T-Cell Therapy
view:
New-to-Market Part B Medications
view:
Non-Covered Benefit
view:
Non-Preferred DME
view:
Part B Drugs Requiring Prior Authorization
view:
Pulmonary Rehabilitation
view:
Radiofrequency Ablation for Lung Cancer
view:
Ramps
view:
Recommendations for Intermittent Skilled Therapy in a SNF
view:
Recommendations for Skilled Nursing
view:
Repairs and Modifications of Durable Medical Equipment (DME)
view:
Rhinoplasty and Septoplasty
view:
Skilled Nursing Facility (SNF) Services Under Medicare Part A
view:
Skin and Soft Tissue Substitutes
view:
Subacute Level of Care in a Skilled Nursing Facility (SNF) Under Medicare Part A
view: