Globalhealth Coverage Criteria
Latest Globalhealth coverage criteria updates4
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Prior authorization and coverage criteria for specialty pharmacy products (partial)This document provides prior authorization requirements and coverage criteria for specific specialty pharmacy products for GlobalHealth Medicare Advantage plans; it affects prescribers and pharmacies submitting PA requests for the listed drugs.All globalhealth updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-05-16Seat Elevation Equipment (Power Operated) on Power Wheelchairs — Coverage CriteriaUpdates coverage to reflect the CMS National Coverage Determination that power-operated seat elevation systems on complex rehabilitation power wheelchairs are reasonable and medically necessary for beneficiaries who meet specified specialized evaluation and functional criteria; affects providers ordering, evaluating, and billing for power seat lift equipment for GlobalHealth members.All globalhealth updates
- Coverage CriteriaClinical/Medical PolicyEff. 2019-03-01Site of Care (hospital outpatient infusion) coverage criteriaDefines when hospital outpatient facility infusion is medically necessary versus preferred alternate sites (home/office) for commercial GlobalHealth members; applies to outpatient injectable drugs/biologics requiring infusion.All globalhealth updates
- Coverage CriteriaClinical/Medical PolicyEff. 2019-01-01Total Knee Arthroplasty (TKA) Coverage CriteriaPolicy governing medical necessity coverage criteria for FDA-approved total knee arthroplasty prostheses for GlobalHealth commercial members, including safety, clinical indications, and coding guidance.All globalhealth updates
Tool Description
Search Globalhealth 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.
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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.
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