CareSource Georgia Coverage Criteria
Latest CareSource Georgia coverage criteria updates24
- Coverage CriteriaClinical/Medical PolicyEff. 2026-09-01Personal Emergency Response SystemsThis policy governs coverage of Personal Emergency Response Systems (PERS) used in a member's home. Coverage may be medically necessary when specified clinical, functional, living-arrangement, equipment-use, telephone-support, and CareSource Case Management criteria are met.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01ProACT Adjustable Continence TherapyMedical policy governing coverage and medical necessity criteria for ProACT adjustable continence therapy for male post-prostate surgery stress urinary incontinence for CareSource Georgia members.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Mechanical Stretching Devices (Dynamic Splinting) — Coverage CriteriaCoverage rules for mechanical stretching (dynamic splinting) devices as durable medical equipment (DME) for members of CareSource Marketplace plans in specified states, including medical necessity criteria, non-covered indications, and device-type determinations.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Transcranial Magnetic Stimulation for Treatment of DepressionMedical necessity and coverage criteria for use of transcranial magnetic stimulation to treat major depressive disorder in adults, including initial, continuation, and repeat courses, and device/administration requirements for providers and payers.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Insulin Infusion PumpClinical policy governing medical necessity, coverage criteria, exclusions, and replacement/repair rules for external insulin infusion pumps and sensor-augmented systems for members covered by CareSource (Marketplace plans listed). Applies to providers seeking authorization or coverage for pumps and related services.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Radiofrequency and Microwave Ablation of TumorsDefines medical necessity, coverage criteria, and limitations for radiofrequency (RFA) and microwave (MWA) thermal ablation of tumors for CareSource Georgia members; applies to clinical indications including liver, lung, kidney, thyroid, bone, soft tissue, and select benign conditions. Affects providers requesting authorization or billing for these procedures under this payer policy.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-05-01Standing frames (non-powered) coverage criteriaPolicy governing medical necessity review and coverage criteria for non-powered standing frames (standers) for CareSource Marketplace members in specified states; applies to providers requesting DME for members who cannot stand independently.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-04-01Trigger Point InjectionsMedical policy governing coverage and payment criteria for trigger point injections (TPIs) for back, neck, and myofascial pain for CareSource Marketplace members in listed markets; describes medical necessity criteria, documentation, and payment guidance for providers.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-03-01Epidural Steroid InjectionsMedical necessity and coverage criteria for epidural steroid injections (ESIs) for members covered by CareSource Georgia Marketplace plans, including initial diagnostic and subsequent therapeutic injections and limitations on frequency and technique.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-03-01Intraosseous Basivertebral Nerve AblationDefines CareSource Georgia coverage criteria for intraosseous basivertebral nerve ablation (e.g., Intracept) to treat vertebrogenic chronic low back pain and specifies when the procedure is medically necessary, not medically necessary, and reimbursement limitations for members covered by CareSource (Georgia and listed marketplaces).All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-03-01Neonatal Discharge CriteriaDefines clinical criteria for medically appropriate discharge of neonates (non-technology-dependent and technology-dependent) from the neonatal unit; intended for providers managing NICU discharge planning for CareSource Georgia members.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-02-01Inhaled Nitric Oxide (iNO) coverage criteriaClinical coverage policy for initiation, appropriate uses, limitations, and non-covered indications for inhaled nitric oxide (iNO) therapy for CareSource Marketplace members (applies to listed markets).All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Safety BedsThis policy governs medical necessity coverage criteria and documentation requirements for safety beds (enclosed/ensemble special-needs beds) furnished to CareSource Marketplace members; it affects providers seeking prior authorization and reimbursement for safety beds and related assessment and monitoring plans.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Special Needs Car SeatsPolicy governing medical necessity, documentation, and coverage criteria for special needs car seats (adaptive car seats, vests, and related restraints) for members with functional needs who have outgrown conventional 5-point harness child restraint systems.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-12-01Skin Substitutes — Medical Policy (coverage criteria)Clinical policy governing medical necessity, documentation, and coverage limits for use of skin substitute products (including cellular and tissue-based products) for treatment of chronic wounds, burns, and scar contractures for CareSource Marketplace members.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-11-01Myoelectric Lower Extremity Prosthetic TechnologyDefines medical necessity criteria and documentation requirements for coverage of myoelectric (microprocessor-controlled) additions to lower-extremity prostheses for CareSource members.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-11-01Peroral Endoscopic Myotomy (POEM) — Coverage CriteriaThis medical policy defines clinical coverage criteria, contraindications, and related guidance for Peroral Endoscopic Myotomy (POEM) for treatment of achalasia for CareSource Georgia members.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-11-01Personal Emergency Response SystemsDefines medical necessity and coverage criteria for in-home Personal Emergency Response Systems for CareSource Georgia members, including eligibility, required documentation, and case management assessment.All CareSource Georgia updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2025-10-01Digital EEG Spike AnalysisDefines CareSource Georgia's reimbursement stance for digital EEG spike analysis (CPT 95957) and the clinical scenarios in which it is considered medically necessary; applies to Marketplace lines in multiple states and affects providers submitting claims for EEG-related services.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-09-01Nutritional SupportsDefines medical necessity, coverage criteria, and exclusions for oral and enteral nutrition products, donor human milk, and related supplies for Marketplace members in the listed states; affects providers requesting nutritional supports for members.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-09-01ProACT Adjustable Continence TherapyMedical policy governing coverage and clinical criteria for ProACT adjustable continence therapy for male post-surgical stress urinary incontinence for CareSource Georgia members.All CareSource Georgia updates
- Coverage CriteriaAdministrative/Operational PolicyEff. 2025-06-01Cystic Fibrosis TestingDefines CareSource Marketplace coverage and medical necessity criteria for cystic fibrosis (CF) genetic and diagnostic testing, including carrier screening and diagnostic indications, and applies to Marketplace members in listed states.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-04-03Routine Hearing Services, Hearing Aids, and Related Services (Coverage Criteria)Defines coverage, limits, provider network, and related services for routine hearing services and hearing aids for CareSource Marketplace Ohio members, including administration by TruHearing and age-based benefit limits.All CareSource Georgia updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-04-03Vision, Hearing Aid, and Active & Fit Fitness Rider Coverage CriteriaAmendments to the Evidence of Coverage describing routine hearing services and hearing aid coverage administered via TruHearing, adult vision benefits administered via EyeMed, and the Active & Fit fitness program; governs covered persons under the CareSource Ohio rider and network/provider use requirements.All CareSource Georgia updates
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Tool Description
Search CareSource Georgia 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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