Geisinger Health Plan Coverage Criteria
- Geisinger Health Plan prior authorization
- Geisinger Health Plan contact directory
- All Geisinger Health Plan policy updates
Latest Geisinger Health Plan coverage criteria updates12
- Coverage CriteriaClinical/Medical PolicyEff. 2025-02-01Adcetris (brentuximab vedotin) medical benefit coverageDefines medical necessity criteria and prior authorization requirements for Adcetris (brentuximab vedotin) for Geisinger Health Plan members across applicable lines of business. Affects providers prescribing or requesting coverage for Adcetris.All Geisinger Health Plan updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-07-18Absorbable Hydrogel SpacerPolicy governing coverage of FDA‑approved absorbable rectal hydrogel spacers (e.g., SpaceOAR) to reduce rectal and urinary toxicity for men undergoing radiotherapy for prostate cancer; applies to Geisinger Health Plan lines of business per member benefit documents.All Geisinger Health Plan updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-04-01Total Parenteral NutritionThis policy governs coverage criteria, indications, limitations, and coding guidance for Total Parenteral Nutrition (TPN) for Geisinger Health Plan members across applicable lines of business.All Geisinger Health Plan updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-02-04Automated Ambulatory Blood Pressure MonitoringThis medical benefit policy governs coverage criteria, limitations, exclusions, and coding guidance for automated ambulatory blood pressure monitoring (AABPM) for Geisinger Health Plan members across commercial, Medicare, CHIP, and Medicaid lines of business.All Geisinger Health Plan updates
- Coverage CriteriaClinical/Medical PolicyEff. 2014-01-14TonsillectomyDefines medical necessity criteria, coding, and coverage stance for tonsillectomy (with or without concurrent procedures) for Geisinger Health Plan members across applicable lines of business.All Geisinger Health Plan updates
- Coverage CriteriaClinical/Medical PolicyEff. 2006-03-13Trigger Point InjectionsPolicy governing medical necessity and coverage criteria for trigger point injections for chronic neck/back or myofascial pain for Geisinger Health Plan members across applicable lines of business.All Geisinger Health Plan updates
- Coverage CriteriaClinical/Medical PolicyAkynzeo IV (fosnetupitant/palonosetron)Medical benefit pharmaceutical policy governing prior authorization and medical necessity criteria for Akynzeo IV for prevention of chemotherapy-induced nausea and vomiting across applicable Geisinger Health Plan lines of business.All Geisinger Health Plan updates
- Coverage CriteriaReimbursement/Payment PolicyAmbulance Transport ServiceThis policy defines coverage, medical necessity criteria, and requirements (including prior authorization) for ambulance transport services provided to Geisinger Health Plan members across its lines of business.All Geisinger Health Plan updates
- Coverage CriteriaClinical/Medical PolicyAponvie (aprepitant) — Medical Benefit Pharmaceutical PolicyThis medical benefit pharmaceutical policy governs prior authorization and coverage criteria for Aponvie (aprepitant) for prevention of postoperative nausea and vomiting (PONV) for Geisinger Health Plan members across applicable commercial, Medicare, and CHIP lines of business.All Geisinger Health Plan updates
- Coverage CriteriaClinical/Medical PolicyAquatic TherapyThis policy governs coverage and medical necessity criteria for aquatic therapy services for Geisinger Health Plan members across applicable lines of business. It outlines indications, limitations, exclusions, and coding guidance for providers requesting or delivering aquatic therapy.All Geisinger Health Plan updates
- Coverage CriteriaClinical/Medical PolicyTransmyocardial Laser RevascularizationThis policy governs coverage criteria and definitions for transmyocardial laser revascularization (TMLR) for Geisinger Health Plan members across applicable lines of business. It affects providers submitting requests for TMLR and medical directors/management assessing medical necessity.All Geisinger Health Plan updates
- Coverage CriteriaClinical/Medical PolicyTransoral Incisionless FundoplicationDefines coverage, prior authorization requirements, and clinical criteria for Transoral Incisionless Fundoplication (including EsophyX/SerosaFuse) for Geisinger Health Plan members across Commercial, Medicare, and Medicaid business segments.All Geisinger Health Plan updates
1–12 of 12
1 / 1
Tool Description
Search Geisinger Health Plan 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.
Coverage Criteria by Payer
Go deeper
Explore OpenPayer Data
Coverage policies are updated every day. Follow payer coverage policy updates in the live policy feed, or browse all CPT, HCPCS and DRG billing codes.
Toolbox
More OpenPayer Tools
- Billing Code LookupSearch CPT, HCPCS, J-codes, DRG, and dental codes by number or procedure name.
- Billing Code Reimbursement RatesBuild a reimbursement rate report across any mix of billing codes and states, comparing commercial payers against Medicare.
- Payer Comparison DashboardPick 2-5 payers to compare market share, premium, and membership by region, all at once.
- Facility Comparison DashboardPick 2-6 hospital facility types (or add a specific hospital) to compare facility count, revenue, net income, and Medicare/Medicaid payer mix by region, all at once.
- Healthcare Provider & Facility LookupFind hospitals and healthcare facilities by name, taxonomy, facility type, ownership, or state.
- Health Insurance Payer LookupSearch national health insurance payers and health plans by name and state presence.
- Provider Taxonomy Code LookupSearch NUCC taxonomy codes by code, specialty, grouping, or classification.
- CPT Modifier LookupSearch CPT modifiers by code or name — descriptions, when to use them, and payer policy context.
- Prior Authorization LookupSearch payer prior authorization policies by drug, procedure, or policy name.
- Timely Filing LookupFind payer timely filing policies: claim deadlines, corrected claim windows, and appeal timeframes.
- Payer Contact DirectoryClaims, prior authorization, provider services, and appeals contacts for health insurance payers.
Published by
Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.