Ambetter Nevada Coverage Criteria
Latest Ambetter Nevada coverage criteria updates25
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Allogeneic Hematopoietic Progenitor Cell Therapy (Omisirge, RegeneCyte)Medical necessity criteria and coverage guidance for allogeneic hematopoietic progenitor cell therapies (Omisirge/omidubicel and RegeneCyte/HPC Cord Blood) for non‑Medicare Ambetter Nevada plans.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Clinical Policy: Air AmbulanceMedical necessity criteria and coding guidance for fixed-wing and rotary-wing air ambulance transport for members/enrollees of Ambetter Nevada (Centene-affiliated health plans). Applies to requests for emergent and interfacility air transport when ground or water transport is inappropriate or unavailable.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Immobilized Lipase Cartridges (RELiZORB)Medical necessity criteria and coverage guidance for RELiZORB immobilized lipase cartridges used with enteral feeding for members/enrollees of Ambetter Nevada (Centene-affiliated health plans). Affects providers requesting coverage for RELiZORB cartridges.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Liposuction for Lipedema (PDF)Defines medical necessity criteria for liposuction to treat lipedema for health plans affiliated with Centene Corporation, and states that liposuction is not medically necessary for indications outside these criteria. Includes coding implications referencing CPT codes for suction-assisted lipectomy.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Multiple Sleep Latency Testing (MSLT) Coverage CriteriaCriteria and coding guidance for when MSLT is considered medically necessary for evaluation of suspected narcolepsy or idiopathic hypersomnia for members/enrollees of Ambetter Nevada (Centene-affiliated health plans).All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Pediatric Oral Function Therapy (Coverage Criteria)Defines medical necessity criteria and continuation requirements for pediatric oral function therapy for children with feeding, swallowing, or oral function impairments; applies to health plans affiliated with Centene (Ambetter Nevada).All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Therapeutic Utilization of Inhaled Nitric OxideGoverns medical necessity criteria and continuation for inhaled nitric oxide therapy for neonates, infants, children, and select adult indications (including COVID-19/ARDS rescue therapy) for members of Ambetter Nevada (Centene-affiliated health plans).All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Pancreas TransplantationMedical necessity criteria, contraindications, and coding guidance for pancreas transplantation procedures (PTA, SPK, PAK) and autologous islet cell transplant as an adjunct to pancreatectomy; applies to Ambetter Nevada members/enrollees and providers requesting coverage.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Tandem TransplantMedical necessity criteria and coding guidance for planned sequential (tandem) high-dose therapy with hematopoietic cell transplant, primarily autologous transplants (and specified autologous→allogeneic sequences) for diagnoses including multiple myeloma, certain germ cell tumors, and high‑risk neuroblastoma; applies to members/enrollees of Centene-affiliated health plans (Ambetter Nevada).All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Assisted Reproductive Technology (ART) Coverage CriteriaDefines medical necessity, covered services, and exclusions for assisted reproductive technologies (ART) for members whose benefit plans include infertility coverage. Applies to clinical treatments and laboratory procedures handling gametes and embryos for establishing pregnancy.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Clinical Policy: Home VentilatorsMedical necessity criteria for provision and continued use of noninvasive and invasive home ventilators for non‑Medicare health plans affiliated with Centene (Ambetter Nevada). Affects providers requesting coverage for home ventilators for enrolled members.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Deep Transcranial Magnetic Stimulation for Treatment of Obsessive Compulsive Disorder (PDF)Defines medical necessity criteria, contraindications, limits, and coding guidance for deep transcranial magnetic stimulation (dTMS) to treat OCD for health plans affiliated with Centene Corporation (Ambetter Nevada). Includes initial treatment, maintenance (not medically necessary), and retreatment review criteria.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Donor Lymphocyte InfusionMedical necessity criteria for donor lymphocyte infusion following allogeneic hematopoietic stem cell transplantation for relapsed or high-risk hematologic malignancies; applies to non-Medicare Ambetter Nevada/Centene-affiliated health plans.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Nerve Blocks and Neurolysis for Pain ManagementDefines medical necessity, coverage criteria, and limitations for a range of peripheral and sympathetic nerve blocks and neurolysis procedures for non‑Medicare Ambetter Nevada members, including diagnostic and therapeutic uses and indications where treatment is not supported.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Pediatric Kidney Transplant Coverage CriteriaMedical necessity criteria for pediatric kidney transplantation for non-Medicare health plans affiliated with Centene (pediatric members <18), including indications, contraindications, and coding references.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Transcranial Magnetic Stimulation for Treatment Resistant Major Depression (PDF)Defines medical necessity criteria, contraindications, device requirements, session limits, and review processes for initial, adolescent, retreatment, and maintenance use of rTMS, dTMS, and iTBS for major depressive disorder.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Biofeedback for Behavioral Health DisordersDefines medical necessity criteria, limits, and clinical guidance for outpatient biofeedback/neurofeedback as an adjunctive treatment for certain behavioral health diagnoses for members/enrollees of Centene Advanced Behavioral Health and affiliated health plans.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Clinical Policy: BiofeedbackMedical necessity and coverage criteria for biofeedback therapy across specified clinical indications for members/enrollees of the health plan.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep ApneaDefines medical necessity criteria, patient selection, contraindications, and coding for implantable hypoglossal (upper airway) nerve stimulation systems (Inspire® and Genio®) for treatment of moderate to severe OSA for Ambetter Nevada members.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Nonmyeloablative / Reduced‑Intensity Allogeneic Hematopoietic Stem Cell TransplantationDefines medical necessity criteria, exclusions, and coding implications for nonmyeloablative (reduced‑intensity conditioning, RIC) allogeneic hematopoietic stem cell transplants for members of the health plans affiliated with Centene (Ambetter Nevada). Applies to requests for allogeneic HCT using nonfully ablative regimens and describes diagnoses supported and not supported for coverage.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Obstetrical Home Care ProgramsMedical necessity criteria and coverage stance for obstetrical home health programs and services provided by home health vendors for pregnant and postpartum members/enrollees.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Outpatient Oxygen Use (Clinical Policy)Clinical coverage criteria for outpatient/home oxygen therapy, portable systems, and related equipment for pediatric and adult members/enrollees of Ambetter Nevada (Centene-affiliated health plans).All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Skin and Soft Tissue Substitutes for Diabetic Foot Ulcers and Venous Leg UlcersMedical necessity criteria, documentation, coding, and coverage limits for use of skin and soft tissue substitutes (cellular and tissue-based products) to treat diabetic foot ulcers (DFU) and venous leg ulcers (VLU) for non-Medicare Ambetter Nevada plans.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Total Parenteral Nutrition (TPN) and Intradialytic Parenteral Nutrition (IDPN)Medical necessity criteria and coding implications for provision of TPN and IDPN for Ambetter Nevada members/enrollees, including indications, not-proven indications, approval durations, and background clinical context.All Ambetter Nevada updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-04-01Allergy Testing and Therapy (Clinical Policy)Medical necessity, limitations, and coverage criteria for diagnostic allergy testing and allergen immunotherapy (skin, in vitro, patch, challenge testing and immunotherapy) for Ambetter Nevada members.All Ambetter Nevada updates
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Search Ambetter Nevada 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.
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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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