Arizona Complete Health Coverage Criteria
Latest Arizona Complete Health 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 plans administered by the health plan.All Arizona Complete Health 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 when ground or water ambulance transport is inappropriate; applies to health plans affiliated with Centene Corporation and their members/enrollees.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Drugs of Abuse: Definitive (Confirmatory) TestingOutpatient definitive (quantitative) drug testing coverage criteria for urine and serum drug levels, who may qualify, and tests considered not medically necessary for Arizona Complete Health members under Centene policies.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Immobilized Lipase Cartridges (RELiZORB)Defines medical necessity criteria for use of RELiZORB immobilized lipase cartridges with enteral feeding for members/enrollees of the health plan; applies to requests for cartridge coverage when treating exocrine pancreatic insufficiency (EPI).All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Liposuction for LipedemaDefines medical necessity criteria and coding information for liposuction as a treatment for lipedema for members of Arizona Complete Health (Centene-affiliated health plans). Applies to providers requesting coverage for liposuction for lipedema.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Multiple Sleep Latency TestingDefines medical necessity criteria and coding guidance for Multiple Sleep Latency Testing (MSLT) for members/enrollees, including initial and repeat testing, and special pediatric requirements. Applies to health plans affiliated with Centene Corporation (Arizona Complete Health payer policy).All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Pediatric Oral Function TherapyDefines medical necessity criteria and continuation requirements for pediatric oral function therapy for children with feeding, swallowing, or oral function disorders; applies to health plans affiliated with Centene Corporation (Arizona Complete Health).All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Pulmonary Function Testing (PFT)Medical necessity criteria and coding guidance for pulmonary function testing (spirometry, lung volumes, DLCO, exercise testing and related PFTs) for members aged three years and above affiliated with Centene/AZ Complete Health.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Tandem Transplant (Tandem hematopoietic cell transplant — autologous ± allogeneic)Medical necessity criteria and coverage stance for planned sequential (tandem) high-dose therapy and hematopoietic cell transplant within six months of the first transplant for members of Arizona Complete Health (Centene-affiliated plans). Applies to providers requesting authorization for tandem autologous and tandem autologous→allogeneic transplants for specified diagnoses.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Assisted Reproductive Technology (ART) — Coverage CriteriaDefines medical necessity, covered procedures, and exclusion criteria for assisted reproductive technologies for members whose benefit plans include infertility services. Applies to clinical providers and benefits administrators determining coverage for ART for eligible members/enrollees.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Clinical Policy: Heart-Lung TransplantMedical necessity criteria and coverage guidance for heart-lung transplantation for members of the health plans affiliated with Centene Corporation (Arizona Complete Health). Applies to evaluation, listing, and contraindications for combined heart and lung transplant.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Donor Lymphocyte InfusionMedical necessity criteria and coding guidance for donor lymphocyte infusion following allogeneic hematopoietic stem cell transplantation for relapsed or high-risk hematologic malignancies; applies to non-Medicare Arizona Complete Health plans adopting this Centene policy.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Home Ventilators (noninvasive and invasive)Medical necessity criteria and coverage guidance for initial and continued use of home noninvasive and invasive ventilators for non‑Medicare health plans affiliated with Centene Corporation, affecting providers caring for eligible members/enrollees.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Lung TransplantationDefines medical necessity criteria for lung transplantation for non-Medicare Arizona Complete Health members/enrollees with end-stage chronic lung disease, based on ISHLT 2021 guidance; includes adult and pediatric indications, contraindications, and coding implications.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Nerve Blocks and Neurolysis for Pain ManagementClinical coverage criteria for peripheral nerve blocks, sympathetic blocks, celiac plexus blocks/neurolysis, intercostal and peripheral/ganglion blocks, occipital nerve blocks, and intraosseous basivertebral nerve ablation for non-Medicare plans affiliated with Centene/AZ Complete Health.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Pediatric Kidney TransplantMedical necessity criteria and coverage guidance for pediatric kidney transplantation for non‑Medicare health plans affiliated with Centene/AZ Complete Health, applicable to members under 18 years of age.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Biofeedback for Behavioral Health DisordersMedical necessity and coverage criteria for biofeedback used as an adjunctive behavioral health treatment for members with specified diagnoses, governing authorization, continuation, and discharge decisions for covered health plans affiliated with Centene.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep ApneaMedical necessity criteria and coding guidance for implantable hypoglossal (upper airway) nerve stimulation systems (InspireAll Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Nonmyeloablative Allogeneic Stem Cell TransplantsDefines medical necessity and noncoverage criteria for nonmyeloablative/reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplants for members of Arizona Complete Health (Centene-affiliated plans). Applies to providers requesting authorization for these transplants.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Obstetrical Home Care Programs (Clinical Policy)Medical necessity criteria and coverage stance for obstetrical home health programs provided by vendors for pregnant members, including nurse assessment, infusion therapies, hydration, diabetes and hypertensive disorder management, and dietary analysis.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Outpatient Oxygen UseGoverns medical necessity criteria, reauthorization, exclusions, and coding for outpatient/home oxygen therapy and related oxygen delivery systems for pediatric and adult members/enrollees of the health plans affiliated with Centene Corporation (applies to Arizona Complete Health members as part of Centene policies).All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Total Parenteral Nutrition and Intradialytic Parenteral NutritionMedical necessity criteria, indications, and coding implications for provision of total parenteral nutrition and intradialytic parenteral nutrition for members/enrollees of Arizona Complete Health (Centene-affiliated plans). Applies to inpatient, outpatient, and home infusion settings as described.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-04-01Evoked Potential TestingThis policy defines medical necessity, coverage criteria, and coding guidance for evoked potential (EP) testing — including somatosensory, brainstem auditory, visual, and motor EPs — for members of health plans affiliated with Centene Corporation (Arizona Complete Health). It applies to providers requesting or performing EP testing.All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-04-01Excimer Laser Therapy for Skin ConditionsDefines medical necessity criteria and coding for excimer (308 nm) laser targeted phototherapy for specific dermatologic conditions and states where evidence is insufficient; applies to health plans affiliated with Centene Corporation (Arizona Complete Health).All Arizona Complete Health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-03-01Clinical Policy: Urodynamic TestingDefines medical necessity criteria, coding, and indications for urodynamic studies used in the evaluation of voiding dysfunction for members/enrollees of Centene-affiliated health plans (Arizona Complete Health).All Arizona Complete Health updates
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Tool Description
Search Arizona Complete Health 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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