Return to Provider News

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.

Related News
UPDATE – Preauthorization Requirements for Select Cardiology Services

Preauthorization Updates Effective October 1, 2022, for All Lines of Business Requiring Preauthorization

Preauthorization Updates Effective May 1, 2022 for All Lines of Business Requiring Preauthorization

Drug-Eluting Sinus Stents for Post-operative use following Endoscopic Sinus Surgery Medical Policy Update Effective September 15, 2022

Musculoskeletal Medical Policy Updates Effective September 15, 2022



Utilization Management

IE Browser Modal