Where to Find Medical Coverage Policies
Understanding the medical necessity criteria outlined in the medical coverage policy of private payers will help you provide appropriate documentation to support your patient’s medical needs.
Understanding the medical necessity criteria outlined in the medical coverage policy of private payers will help you provide appropriate documentation to support your patient’s medical needs. Most payers to make their policies available online. You and your team should familiarize yourself with payers in your town and understand the policies covering the services you provide.
Below are links to some of the policies for the large, national payers.
Aetna
Lower Limb Prostheses Medical Policy
Upper Limb Prostheses Medical Policy
Anthem
Lower Limb Prostheses Clinical Guideline
Myoelectric Upper Extremity Prosthetic Devices Clinical Guideline
Prefabricated and Prophylactic Knee Braces Clinical Guideline
Spinal Orthoses Clinical Guideline
Upper Extremity Myoelectric Clinical Guideline
Microprocessor Controlled Lower Limb Prosthesis Clinical Guideline
Custom Made Knee Braces Clinical Guideline
Myoelectric Upper Extremity Prosthetic Devices Clinical Guideline
Ankle-Foot and Knee-Ankle-Foot Orthoses Clinical Guidelines
Cigna
UHC
Therapeutic Shoes/Diabetic Inserts
You may find other policies by searching for “medical coverage policy” and the insurance company name.