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Medical Necessity Review Criteria Update

Audience: Physicians, Health Care Practitioners and Facilities

Effective July 1, 2022, all requested inpatient mental health and substance use services for Medicare members will be reviewed for medical necessity based on Medicare National Coverage Determinations (NCD) and Local Coverage Determinations (LCD).

Information regarding NCD and LCD criteria effective July 1.

Please confirm member eligibility and authorization requirements before rendering the service. Final determination of coverage is subject to the member’s benefits and eligibility on the date of service.

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