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Policies and Guidelines > Coverage Policies

Coverage Policies

Coverage policies are developed to communicate Medica decisions about coverage and benefits for various medical services. Each coverage policy contains a description of the medical service, as well as the coverage determination, product application, coding considerations and requirements for prior authorization.

Both the coverage policy and utilization management policy sections should be checked to determine coverage for a particular service.

About Utilization Management Policies for medical services that require prior authorization

Important note: Before using these policies, read the Coverage Policies Usage Notice.

Coverage Policies (Alpha Order)

Medical Technology Assessment Submission

Use this form to submit an inquiry regarding a Medica Coverage Policy. Medica makes every effort to conduct a thorough evaluation of new and emerging technologies using an evidence-based approach. The evidence used when making a determination includes well-designed and well-conducted investigations published in peer-reviewed journals, national physician specialty association and consensus or expert panel opinions, technology assessment reports, FDA and other regulatory approval status, and local physician input, including network specialty physicians and other local consensus opinions.

Medical Technology Assessment Submission Form

Date: 7/31/2021 9:30:53 AM Version: 4.0.30319.42000 Machine Name: PWIVE-CDWEB02