Alaska Medicaid Coverage Criteria
Latest Alaska Medicaid coverage criteria updates25
- Coverage CriteriaClinical/Medical PolicyEff. 2022-11-23Orthodontic Services — Coverage Criteria and Prior AuthorizationThis document governs coverage, prior authorization, eligibility, and reimbursement rules for orthodontic services (limited, interceptive, and comprehensive) for Alaska Medicaid and Denali KidCare recipients.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEff. 2021-10-01Frenectomy (Buccal/Labial D7961; Lingual D7962)Defines medical necessity criteria and authorization requirements for buccal/labial and lingual frenectomy services for Alaska Medicaid members; applies to providers performing these dental procedures under Alaska Medicaid.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEff. 2021-05-01Home Non‑Invasive Ventilators (NIPPV) — Coverage Criteria (HCPCS E0466)Defines Alaska Medicaid coverage and medical appropriateness criteria for home non-invasive ventilators (HCPCS E0466), who is eligible, and conditions considered not medically necessary or investigational.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEff. 2021-05-01Private-Duty Nursing (PDN) — Coverage CriteriaDefines Alaska Medicaid clinical eligibility and coverage criteria for private-duty nursing services for eligible individuals under 21 with life‑threatening conditions who require continuous skilled care to avoid hospital or long‑term care placement.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEff. 2017-10-01Clinical Criteria for Use - Hepatitis C Direct-Acting Antiviral AgentsClinical criteria governing Alaska Medicaid coverage and preferred-product selection for hepatitis C direct-acting antiviral agents; affects prescribers, pharmacists, and Alaska Medicaid members.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEff. 2009-10-04Leuprolide acetate injection (Lupron, Eligard) coverageDefines Alaska Medicaid coverage criteria and approval terms for leuprolide acetate injectable products (Lupron, Lupron Depot-Ped, Lupron Depot, Eligard) for pharmacy dispensing. Applies to Alaska Medicaid beneficiaries receiving these drugs.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEff. 2004-07-14Preferred Drug List (PDL) implementation and non-preferred drug coverage criteriaDescribes Alaska Medicaid's implementation and operational requirements for a Preferred Drug List (PDL), notification (soft edit) and denial (hard edit) processes for non-preferred drugs, and what providers and pharmacists must do to document medical necessity to obtain payment. Affects Alaska Medicaid prescribers, pharmacists, and pharmacies.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEff. 2001-01-01Certificate to Request Funds for AbortionForm and procedure for requesting Alaska Medicaid funds to pay for abortions that are not covered by federal Medicaid, applicable to Alaska Medicaid providers and patients when abortions are medically necessary or due to rape/incest.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyAduhelm (aducanumab-avwa) prior authorization - Coverage CriteriaThis document defines Alaska Medicaid prior authorization requirements, clinical criteria, and utilization limits for Aduhelm (aducanumab-avwa) infusions for treatment of Alzheimer's disease.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyAdult Preventive Services Coverage Chart — Coverage CriteriaChart of covered adult preventive services for Alaska Medicaid including required procedure and ICD-10-CM screening codes, age/gender applicability, and billable status for providers submitting preventive service claims.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyAmbulance transportation clinical criteria: medical necessity, service levels, and reimbursement conditionsDefines medical necessity, service-level definitions, and reimbursement conditions for ground ambulance (BLS/ALS) transports for Alaska Medicaid recipients.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyBimzelx (bimekizumab) prior authorization — coverage criteria for plaque psoriasis, psoriatic arthritis, nr-axSpA, and ankylosing spondylitisDefines Alaska Medicaid prior authorization criteria, approval/denial rules, quantity limits, and required documentation for bimekizumab (Bimzelx) for indicated adult inflammatory conditions.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyBotulinum toxin (Botox) prior authorization — multiple indicationsForm and criteria governing prior authorization requests for botulinum toxin (Botox) for Alaska Medicaid members across multiple indications (e.g., chronic migraine, spasticity, hyperhidrosis, dystonias, bladder conditions). Affects prescribers, physician-administered drug billing, and pharmacy requests to Alaska Medicaid.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyBreast PumpsDefines Alaska Medicaid coverage criteria and billing rules for manual (E0602), electric (E0603) and hospital-grade (E0604) breast pumps dispensed by DMEPOS providers, including eligibility timing, documentation and authorization requirements.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyCommon Non-Emergency Medical Travel Events — Coverage CriteriaRules and guidance for arranging non-emergency travel for Alaska Medicaid members for common medical services (therapy, chronic conditions, dental, behavioral health, etc.). Affects providers arranging travel and verifying prior authorization and treatment plan requirements.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyDirect Acting Antivirals for Hepatitis C (HCV) — Coverage CriteriaPrior authorization and quantity limit policy for FDA‑approved direct acting antiviral (DAA) medications for treatment of chronic hepatitis C virus (HCV) infection for Alaska Medicaid members, including approval criteria, authorized regimens, and renewal requirements.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEnteral Nutrition Certificate of Medical Necessity — Coverage CriteriaForms and requirements governing requests for enteral nutrition products and related service authorization for Alaska Medicaid members; affects ordering providers, suppliers, and Alaska Medicaid fiscal agent reviewers.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyEvenity (romosozumab‑aqqg) prior authorization — Coverage criteriaCriteria and authorization details for Alaska Medicaid coverage of Evenity (romosozumab‑aqqg) for treatment of osteoporosis in postmenopausal women at high risk of fracture.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyHome Oxygen Therapy (Oxygen Equipment Order and Medical Necessity Form)This document is an Alaska Medicaid medical necessity/certification form used to request home oxygen equipment and to document testing and clinical criteria for members aged 5 or older (separate form for under 5). It governs providers and suppliers requesting authorization for stationary or portable oxygen equipment.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyKrystexxa (pegloticase) prior authorizationPrior authorization criteria for coverage of Krystexxa (pegloticase) for adults with chronic gout refractory to conventional therapy under Alaska Medicaid.All Alaska Medicaid updates
- Coverage CriteriaAdministrative/Operational PolicyNon-Emergency Medical Transportation (NEMT) and travel coverageGovernance of Alaska Medicaid travel benefits, prior authorization requirements, and coverage criteria for arranging member travel including NEMT, escorts, and emergency transportation; affects Alaska Medicaid members, referring and receiving providers, and transportation coordinators.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyOmalizumab (Xolair) prior authorization criteriaDefines Alaska Medicaid prior authorization clinical criteria, dosing limits, approval durations, and denial/precaution language for Xolair (omalizumab) across its labeled indications.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyOral Enteral Nutrition (Specialized Medical Formulas) — Coverage CriteriaDefines Alaska Medicaid coverage, prior authorization, documentation, clinical indications, limitations, and coordination of benefits for oral enteral nutrition and specialized medical formulas for members whose health conditions prevent adequate intake or absorption.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyPower wheelchair seat elevation accessory — coverage criteria (adopts NCD 280.16)Defines Alaska Medicaid coverage and supplier requirements for power seat elevation accessories for Group 3 power wheelchairs, including clinical eligibility and prior authorization expectations for members and suppliers.All Alaska Medicaid updates
- Coverage CriteriaClinical/Medical PolicyPrior authorization and coverage criteria for Zulresso (brexanolone) infusionCoverage and prior authorization criteria for Zulresso (brexanolone) infusion for treatment of postpartum depression for Alaska Medicaid members and the requirements providers must meet to obtain approval.All Alaska Medicaid updates
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Tool Description
Search Alaska 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.
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