Radiology
Guidelines for imaging modalities, including CT, MRI, MRA, PET, arterial ultrasound, and nuclear scintigraphy.
Cardiovascular
Guidelines for cardiovascular imaging, coronary interventions, cardiac devices, and vascular interventions.
Sleep
Guidelines for testing and treatment of sleep disorders, including obstructive sleep apnea.
Musculoskeletal
Guidelines for spine surgeries, joint surgeries, and interventional pain management.
Rehabilitation
Guidelines for physical therapy, occupational therapy, and speech therapy.
Genetic Testing
Guidelines for genetic testing, including for pharmacogenomics, prenatal diagnosis, cardiac disease, cancer susceptibility, and tumors and malignancies.
Radiation Oncology
Guidelines for radiation therapies, including brachytherapy, image-guided radiotherapy, intensity-modulated radiation therapy, proton beam therapy, and therapeutic radiopharmaceuticals.
Cancer Treatment Pathways and Guidelines
Cancer treatment pathways and guidelines for common types of cancer, including breast cancer, colorectal cancer, prostate cancer, melanoma, lung cancer, and lymphoma.
Post-Acute Care
Guidelines for inpatient rehabilitation, long-term acute care, and skilled nursing facilities.
Surgical Procedures
Guidelines for upper gastrointestinal endoscopy and surgical site of care.
New and Emerging Interventions
Guidelines for new and emerging healthcare interventions defined as drugs, devices, tests, or procedures.
Information for Medicare beneficiaries enrolled in a Medicare Advantage plan available here.
Providers may email us for any questions about guidelines. (For members requesting details on a request, please reach out to the customer service number on the back of the insurance card).
Requests to consider additional published clinical literature or evidence can be submitted here.
You can access Provider Connections, our news blog for prior authorization staff here.