DHA Coverage Criteria
Latest DHA coverage criteria updates25
- Coverage CriteriaClinical/Medical PolicyEff. 2025-08-27NIH Clinical Trials for Serious ConditionsCoverage criteria for routine care associated with qualifying NIH-sponsored or NIH-approved interventional clinical trials for rare, severely debilitating, or life-threatening conditions.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-09-21Liver TransplantationCoverage criteria for liver and living donor liver transplantation, including candidate eligibility, rare-disease indications, colorectal cancer with liver metastases, authorization, and transplant-related services.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-06-29Automatic Blood Pressure MonitorsThis policy addresses blood pressure monitors as durable medical equipment within the DHA Policy Manual.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2021-05-28Cosmetic, Reconstructive, and Plastic Surgery — General GuidelinesGeneral guidelines for cosmetic, reconstructive, and plastic surgery services under the TRICARE surgery benefit.All DHA updates
- Coverage CriteriaReimbursement/Payment PolicyEff. 2020-03-13Remote Physiologic Monitoring (RPM) Reimbursement PolicyTRICARE requirements for coverage, coding, equipment, exclusions, and cost-sharing for medically necessary remote physiologic monitoring services.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2020-01-01Urinary System SurgeryThis policy addresses surgical services involving the urinary system within the DHA surgery policy manual. The available document window contains only the table-of-contents listing and does not provide clinical coverage criteria or operational requirements.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2016-10-03Family TherapyThis document window identifies DHA Policy 6010.60-M as the Family Therapy policy within the TRICARE behavioral health services section. The substantive coverage criteria, authorization requirements, coding, and clinical rules are not present in this window.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2016-10-03Psychiatric and Substance Use Disorder Partial Hospitalization ProgramsThis policy governs psychiatric and substance use disorder partial hospitalization programs under the DHA TRICARE policy manual.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2016-07-18Cardiac RehabilitationCoverage criteria for inpatient and outpatient cardiac rehabilitation services, including qualifying cardiac events, treatment limits, and exclusions.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2013-01-02AbortionsCoverage criteria, exclusions, provider documentation, and coding requirements for abortions within the Obstetrics/Gynecology service domain.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2012-07-27Cochlear ImplantationCoverage criteria for cochlear implantation, including adult and pediatric eligibility, device replacement, documentation, rehabilitation, and contraindications.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2008-05-29Diagnostic Sleep StudiesCoverage criteria, medical-necessity requirements, coding, and provider documentation rules for diagnostic sleep studies, including home testing for adult obstructive sleep apnea.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2007-11-09Integumentary System SurgeryThis policy addresses surgical services involving the integumentary system under the DHA Policy Manual for TRICARE providers.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2006-07-27Hyperbaric Oxygen (HBO) TherapyThis document identifies the DHA policy section governing Hyperbaric Oxygen (HBO) Therapy under Medicine services. The substantive coverage criteria, authorization requirements, documentation requirements, and coding details are not present in this document window.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2005-09-01Durable Equipment (DE) Basic ProgramThis policy governs the Durable Equipment Basic Program, including coverage criteria, medical necessity, equipment rules, documentation, coding, repairs, replacements, upgrades, and mobile medical applications.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2005-09-01ECHO Eligibility for Intellectual DisabilityThis policy section governs eligibility for the Extended Care Health Option (ECHO) when intellectual disability is the qualifying condition.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2005-09-01Emergency and Medical TransportationThis DHA policy manual publication addresses patient transport and ambulance services. The available document window includes ECHO coverage criteria, authorization, documentation, and termination requirements.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2005-09-01TPT5: Policy ManualThis document is a DHA TRICARE policy manual table of contents identifying policy sections that may govern transportation-related services. The available window does not include the substantive transportation coverage, authorization, documentation, or reimbursement requirements.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2005-09-01TRICARE Institutional Care CoverageThis DHA/TRICARE policy manual organizes coverage, payment, authorization, coding, and clinical policy requirements across institutional and other healthcare services; the available portion is limited to the table of contents and does not include substantive institutional-care criteria.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2005-09-01TRICARE Policy Manual Coverage FrameworkThis document is a table of contents for the DHA TRICARE Policy Manual, organizing provider policies across clinical and administrative services; it does not contain substantive coverage requirements.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2004-05-21Anesthesiologist Assistant ServicesThis DHA policy publication is part of the TRICARE Policy Manual and includes the anesthesia coverage section relevant to anesthesiologist assistant services. The available content in this window is limited to the manual table of contents and does not provide substantive provider requirements or coverage criteria.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 2004-03-22Lung Volume Reduction Surgery (LVRS)This document identifies the DHA policy section governing lung volume reduction surgery within the Surgery chapter of the TRICARE Policy Manual.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 1997-01-01Pulsed Irrigation Evacuation (PIE)This policy governs coverage of pulsed irrigation evacuation under the DHA TRICARE durable equipment benefit. The available document window contains only the policy manual table of contents and does not provide the applicable coverage criteria or operational requirements.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 1996-12-01Combined Liver-Kidney Transplantation (CLKT) Coverage CriteriaCoverage criteria and authorization requirements for combined liver-kidney transplantation under the DHA transplant surgery policy manual.All DHA updates
- Coverage CriteriaClinical/Medical PolicyEff. 1996-11-01Stereotactic radiofrequency pallidotomy with microelectrode mapping for Parkinson's diseaseThis policy section addresses stereotactic radiofrequency pallidotomy with microelectrode mapping as a surgical treatment for Parkinson's disease under the DHA surgery policy manual. The substantive coverage criteria and operational requirements are not present in this document window.All DHA updates
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Search DHA 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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