Alabama Medicaid Coverage Criteria
Latest Alabama Medicaid coverage criteria updates8
- Coverage CriteriaAdministrative/Operational PolicyEff. 2025-08-14Home and Community‑Based Living at Home (LAH) Waiver — Application Process and Coverage CriteriaGovernance of Alabama Medicaid's LAH (Living at Home) HCBS waiver program detailing authority, purpose, service descriptions, provider requirements, and settings requirements for individuals with intellectual disabilities aged 3 and above who would otherwise require ICF/IID care.All Alabama Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEff. 2022-04-22Nurse‑Family Partnership (NFP) nurse visiting services — coverage criteriaDefines Alabama Medicaid coverage, provider requirements, recipient eligibility, documentation, visit expectations, and billing rules for Nurse‑Family Partnership nurse visiting services for eligible pregnant recipients and through the infant's second birthday.All Alabama Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEff. 2021-09-13Hospice Care — Coverage CriteriaRules governing Medicaid-covered hospice services in Alabama, including provider requirements, recipient eligibility, documentation, certification, and program administration for full-benefit Medicaid recipients who elect hospice care.All Alabama Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEff. 2021-01-14Family Planning (Chapter 14) - Coverage CriteriaDefines covered family planning services, eligible individuals, Plan First Waiver rules, sterilization consent requirements, covered procedures and supplies, and billing/reporting provisions for providers enrolled with Alabama Medicaid.All Alabama Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEff. 2020-12-14Home Health — Coverage CriteriaState rules governing eligibility, provider participation, covered and noncovered home health services, certification/recertification, visit limits, and billing for Alabama Medicaid home health programs. Applies to participating home health agencies, ordering clinicians, and Medicaid recipients in Alabama.All Alabama Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEff. 2012-01-16Ventilator-Dependent and Qualified Tracheostomy CareRules governing Alabama Medicaid supplemental payment, facility enrollment, staffing, and clinical criteria for nursing facilities that provide care to ventilator-dependent and/or qualified tracheostomy Medicaid residents.All Alabama Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEff. 1982-10-01Nurse Midwife Program — Coverage Criteria for Certified Nurse MidwivesRules governing participation, covered services, billing, reimbursement, and record requirements for certified nurse midwives participating in the Alabama Medicaid program.All Alabama Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEff. 1982-10-01Outpatient Renal Dialysis (ESRD) Services Coverage CriteriaRules governing Medicaid coverage, facility participation, and billing for outpatient maintenance dialysis (hemodialysis and peritoneal dialysis) provided to eligible Alabama Medicaid recipients.All Alabama Medicaid updates
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Tool Description
Search Alabama Medicaid coverage criteria and medical necessity requirements across 21,000+ policies from 170+ payers.
Search a drug (“Wegovy”), a procedure (“knee replacement”), or a policy name, then filter by payer, specialty, policy type, or effective year. Or start from the largest publishers: UnitedHealthcare coverage criteria and Cigna coverage criteria.
Each result links the full policy page, which lists the clinical requirements, covered codes, and effective dates from the source document.
Pair a criteria search with the prior authorization lookup for approval requirements, the timely filing lookup for claim deadlines, the live policy updates feed for the newest payer publications, and payer profiles for contacts and coverage context.
FAQ
Coverage criteria are the specific clinical requirements a payer sets for covering a drug, procedure, or service: diagnoses, symptom duration, prior treatments tried, age limits, and documentation. They are published inside medical policies and clinical criteria documents, and a claim or authorization that does not meet them is denied as not medically necessary.
Coverage Criteria by Payer
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Coverage policies are updated every day. Follow payer coverage policy updates in the live policy feed, or browse all CPT, HCPCS and DRG billing codes.
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