RetiredCareFirstPolicy N/A

Hemoperfusion

Governs coverage stance for hemoperfusion (use of ultrafiltration to remove toxins) for CareFirst members; affects providers seeking coverage for hemoperfusion treatments.

Policy Summary

PayerCareFirst

PolicyHemoperfusion

Policy CodePolicy N/A

Change TypeRetired / Archived

Effective DateN/A

Next Review DateN/A

Key ActionVerify coverage with the member's contract/line of business prior to providing hemoperfusion; prior authorization requirements depend on contract.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1-5typical number of treatments

3/27/2000archival date

overdose; liver failuremedically necessary for

Coverage Criteria

Medically Necessary Indications

Covered when used for life‑threatening conditions as specified

Medically necessary indications: Hemoperfusion is considered medically necessary in the treatment of life-threatening drug overdose OR acute liver failure.

See Policy Guidelines for typical number of treatments (generally one to five). Procedure may be repeated if a second crisis occurs.

This policy was archived on 3/27/2000. As stated in the archived notice, the application of this policy is no longer limited by the diagnoses listed in the policy. Providers should note the archival status when considering historical guidance; benefit determination for current claims will depend on the member's contract and applicable coverage rules rather than restriction to the diagnoses originally listed in this policy.

When hemoperfusion is performed for diagnoses other than life‑threatening drug overdose or acute liver failure, the procedure requires review for medical necessity and may be considered not medically necessary if unsupported. Prior review is recommended to avoid claim denial.

Provider Actions & Authorization

Policy Summary

PayerCareFirst

PolicyHemoperfusion

Policy CodePolicy N/A

Change TypeRetired / Archived

Effective DateN/A

Next Review DateN/A

Key ActionVerify coverage with the member's contract/line of business prior to providing hemoperfusion; prior authorization requirements depend on contract.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Prior Authorization

Verify benefits / prior authorization

Verify coverage with the member's contract and line of business prior to providing hemoperfusion. Prior authorization and benefit coverage vary by contract and line of business and must be confirmed before scheduling or delivering services.

Confirm member eligibility and benefits for hemoperfusion prior to treatment.
Check prior authorization requirements for the member's specific contract and line of business; obtain PA when required.

Denial Risk

Review required for other diagnoses

If hemoperfusion is performed for a diagnosis other than life‑threatening drug overdose or acute liver failure, the service should be submitted for review to determine medical necessity.

Document clinical indication clearly when the indication is not life‑threatening drug overdose or acute liver failure.
Submit supporting clinical records for medical necessity review when required by the payer.

Note

Benefit verification

Coverage varies by contract and line of business; verify benefits before applying policy.

Benefit verification is required for each member and episode of care.
Do not assume coverage based on another member's plan or prior episodes.

Documentation Required

(Fallback) Provider action

If no specific provider-action is documented in the plan, include a provider-action to verify benefits and obtain any required authorizations as a fallback.

As a fallback, always verify eligibility and obtain prior authorization when indicated.
Retain authorization documentation in the medical record and submit upon request.

OpenPayer

Hemoperfusion

Coverage Criteria

Provider Actions & Authorization

Background

Definitions