On February 21, 2024, Change Healthcare experienced a cyber security incident. Any individuals impacted by this incident will receive a letter in the mail. Learn more about this from Change Healthcare, or reach out to the contact center at 1-866-262-5342.
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.184 Home Ventilators (PDF)
- MC.CP.MP.185 Skin Substitutes for Chronic Wounds of the Lower Extremities (PDF)
- MC.CP.MP.190 Outpatient Oxygen Use (PDF)
- MC.CP.MP.246 Pediatric Kidney Transplantation (PDF)
- MC.CP.MP.247 Transplant Service Documentation Requirements (PDF)
- MC.CP.MP.248 Facility-based Sleep Studies for Obstructive Sleep Apnea (PDF)
- MC.CP.MP.249 Omisirge (Omidubicel): Nicotinamide-Modified Allogeneic Hematopoietic Progenitor Cell Therapy (PDF)
- MC.CP.MP.250 Lantidra (donislecel): Allogeneic Pancreatic Islet Cellular Therapy (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.
- V1.2024 Concert Genetics Oncology: Algorithmic Testing (PDF)
- V1.2024 Concert Genetic Testing: Aortopathies and Connective Tissue Disorders (PDF)
- V1.2024 Concert Genetic Testing: Cardiac Disorders (PDF)
- V1.2024 Concert Genetics Oncology: Cancer Screening (PDF)
- V1.2024 Concert Genetics Oncology: Circulating Tumor DNA and Circulating Tumor Cells Liquid Biopsy (PDF)
- V1.2024 Concert Genetics Oncology: Cytogenetic Testing (PDF)
- V1.2024 Concert Genetic Testing: Dermatologic Conditions (PDF)
- V1.2024 Concert Genetic Testing: Epilepsy, Neurodegenerative, and Neuromuscular Conditions (PDF)
- V1.2024 Concert Genetic Testing: Exome and Genome Sequencing for the Diagnosis of Genetic Disorders (PDF)
- V1.2024 Concert Genetic Testing: Eye Disorders (PDF)
- V1.2024 Concert Genetic Testing: Gastroenterologic Disorders (non-cancerous) (PDF)
- V1.2024 Concert Genetic Testing: General Approach to Genetic Testing (PDF)
- V1.2024 Concert Genetic Testing: Hearing Loss (PDF)
- V1.2024 Concert Genetic Testing: Hematologic Condition (non-cancerous) (PDF)
- V1.2024 Concert Genetic Testing: Hereditary Cancer Susceptibility (PDF)
- V1.2024 Concert Genetic Testing: Immune, Autoimmune, and Rheumatoid Disorders (PDF)
- V1.2024 Concert Genetic Testing: Kidney Disorders (PDF)
- V1.2024 Concert Genetic Testing: Lung Disorders (PDF)
- V1.2024 Concert Genetics Oncology: Molecular Analysis of Solid Tumors and Hematologic Malignancies (PDF)
- V1.2024 Concert Genetic Testing: Metabolic, Endocrine, and Mitochondrial Disorders (PDF)
- V1.2024 Concert Genetic Testing: Multisystem Inherited Disorders, Intellectual Disability, and Developmental Delay (PDF)
- V1.2024 Concert Genetic Testing: Non-Invasive Prenatal Screening (NIPS) (PDF)
- V1.2024 Concert Genetic Testing: Pharmacogenetics (PDF)
- V1.2024 Concert Genetic Testing: Preimplantation Genetic Testing (PDF)
- V1.2024 Concert Genetic Testing: Prenatal and Preconception Carrier Screening (PDF)
- V1.2024 Concert Genetic Testing: Prenatal Diagnosis via Amniocentesis, CVS or PUBS and Pregnancy Loss (PDF)
- V1.2024 Concert 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