Eocco Coverage Criteria
Latest Eocco coverage criteria updates25
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-09Surface Radiation Therapy for Treatment of Non-Melanoma Skin CancerDefines medical necessity, prior authorization documentation, coding, and exclusions for use of surface radiation therapy (SRT) to treat superficial non-melanoma skin cancers (BCC and cSCC) for the payer's covered population.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Air Ambulance TransportEOCCO policy governing coverage and criteria for emergent, urgent, and scheduled non-emergent air ambulance (fixed wing or rotary wing) transport for members; affects providers requesting or delivering air medical transport for EOCCO members.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Air ambulance transport coverage criteriaDefines medical necessity, coverage criteria, documentation, and billing codes for emergent, urgent, and scheduled non-emergent air ambulance transport for Moda/Eocco members.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Botox® (onabotulinumtoxinA) coverageDefines prior authorization, dosing limits, and medical necessity criteria for onabotulinumtoxinA (Botox) across multiple indications for EOCCO members and providers requesting coverage.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Cinqair (reslizumab) (Intravenous) — Coverage CriteriaCriteria, dosing, coding, and prior authorization rules governing coverage of intravenous reslizumab (Cinqair) for members of the plan, including initial and renewal authorization requirements and concomitant therapy prohibitions.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Denosumab (multiple brands) — Prior Authorization and Coverage CriteriaDefines prior authorization, dosing limits, and medical necessity criteria for denosumab products (various brands/biosimilars) for EOCCO members; applies to providers requesting coverage/authorization for these agents.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Dysport (abobotulinumtoxinA) coverageThis policy governs prior authorization, dosing limits, and medical necessity criteria for Dysport (abobotulinumtoxinA) for multiple intramuscular, intradetrusor, and intradermal indications for members of the payer (EOCCO). It affects prescribers and facilities requesting coverage and prior authorization.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Fasenra (benralizumab) (Subcutaneous) prior authorization and coveragePolicy governing prior authorization, dosing limits, initial and renewal medical necessity criteria, and concomitant therapy restrictions for Fasenra (benralizumab) for Eocco members.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Genetic Testing — Coverage Criteria for Genetic & Molecular TestingPolicy governing medical necessity, coverage, and prior authorization requirements for genetic and molecular testing for eocco members, including prenatal, diagnostic, tumor marker assays, and pharmacogenetic tests.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Krystexxa (pegloticase) (Intravenous) — Prior Authorization and Coverage CriteriaDefines prior authorization, dosing limits, approval and renewal criteria, billing codes, and covered diagnoses for use of Krystexxa (pegloticase) for chronic gout in adults.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Medical Nutrition Therapy Coverage CriteriaDefines coverage and medical necessity criteria for medical nutrition therapy (MNT) by registered dietitians for prevention and treatment of obesity, eating disorders, and failure to thrive for Moda/Eocco members.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Myobloc (rimabotulinumtoxinB) — Coverage CriteriaDefines prior authorization, dosing limits, initial and renewal medical necessity criteria for Myobloc (rimabotulinumtoxinB) for multiple indications in adults; applies to providers requesting coverage through EOCCO.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Onpattro (patisiran lipid complex) (Intravenous) coverageThis policy defines prior authorization, dosing, renewal, and medical necessity criteria for intravenous Onpattro (patisiran lipid complex) for treatment of hereditary transthyretin-mediated (hATTR) amyloidosis with polyneuropathy for members covered by eocco.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Palonosetron: Aloxi®; Posfrea™ (Intravenous) — Coverage CriteriaDefines prior authorization, dosing limits, and medical necessity criteria for intravenous palonosetron products (Aloxi and Posfrea) for prevention of chemotherapy-induced nausea and vomiting (CINV) and post-operative nausea and vomiting (PONV). Applies to eocco payer benefit administration.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Radicava (edaravone) (Intravenous) — Coverage CriteriaDefines prior authorization, dosing limits, eligibility, renewal, and billing for intravenous edaravone (Radicava) for treatment of amyotrophic lateral sclerosis (ALS) for Eocco members.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Spinal Cord Stimulators (Dorsal Column Stimulators)Medical necessity and coverage criteria for trial and permanent implantation of spinal cord stimulators, including neuropathic pain and refractory angina; prior authorization and documentation requirements for members and providers.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Temporomandibular Joint (TMJ) Non-Surgical TreatmentDefines coverage, clinical criteria, coding, and prior authorization documentation for non-surgical TMJ treatments for eocco members; applies to providers submitting claims for TMJ non‑surgical services under the referenced plans.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-02Crysvita (burosumab-twza) (Subcutaneous) coverage criteriaDefines prior authorization, dosing, eligibility, monitoring, and renewal criteria for Crysvita (burosumab-twza) for X-linked hypophosphatemia (XLH) and tumor-induced osteomalacia (TIO) for members covered by eocco.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-02Ocrevus (ocrelizumab) (Intravenous) — Coverage CriteriaClinical prior authorization and medical necessity criteria for ocrelizumab (Ocrevus) intravenous administration for multiple sclerosis including dosing, renewal, and monitoring requirements for providers requesting coverage.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Intervertebral Disc Prosthesis (Total Disc Arthroplasty)Medical necessity and coverage criteria for FDA‑approved cervical and lumbar intervertebral disc prostheses, including prior authorization documentation and coding, for Eocco members.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Magnetic Resonance–Guided Focused Ultrasound (MRgFUS) for Essential TremorMedical necessity and coverage criteria for magnetic resonance-guided focused ultrasound (MRgFUS) as a treatment for medication‑refractory essential tremor, applicable to eocco members and providers submitting prior authorization.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Treatment of Urinary and Fecal IncontinenceMedical necessity and coverage criteria for procedures and devices used to treat urinary and fecal incontinence (including sacral nerve stimulation, posterior tibial nerve stimulation, artificial urinary sphincter, bulking agents, and other modalities) for members of the plan.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Vagus Nerve Stimulation (VNS)Clinical coverage and medical necessity criteria for implantable vagus nerve stimulation (VNS) systems as adjunctive therapy for medically refractory partial/focal onset seizures, and coverage stance for other indications. Applies to Eocco plan administration and providers requesting authorization or replacement of VNS devices.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Vagus Nerve Stimulation (VNS) Coverage CriteriaDefines EOCCO medical necessity, coverage, coding, and prior authorization documentation requirements for implantable vagus nerve stimulation devices used primarily to treat medically refractory focal/partial onset seizures in eligible members.All eocco updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Vitamin D TestingPolicy governing medical necessity and coverage of serum vitamin D tests (25-hydroxyvitamin D and 1,25-dihydroxyvitamin D) for members; applies to providers submitting claims to the payer.All eocco updates
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Tool Description
Search Eocco 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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