Husky_health Coverage Criteria
Latest Husky_health coverage criteria updates25
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Baroreflex stimulation device (baroreflex activation therapy) coverage criteriaDefines HUSKY Health prior authorization and medical necessity guidelines for implantation, interrogation, evaluation, revision, and removal of baroreflex stimulation devices for Connecticut Medicaid (HUSKY) members.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Corneal Cross‑linking (CXL) ProcedureDefines medical necessity, prior authorization requirements, coverage criteria, and documentation needed for corneal cross-linking (CXL) for members of the HUSKY Health (Connecticut Medicaid) program.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-08-01Corneal surgical procedures (excluding corneal collagen cross-linking)Defines prior authorization requirements and medical necessity review criteria for corneal surgical procedures (other than corneal collagen cross-linking) for providers enrolled in the Connecticut Medical Assistance Program (HUSKY Health). Affects CMAP providers requesting authorization for listed corneal surgeries.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-02-01Double balloon enteroscopy (DBE) coverage criteriaDefines medical necessity, prior authorization, and documentation requirements for double balloon enteroscopy for Connecticut Medicaid (HUSKY) providers, affecting CMAP-enrolled providers and beneficiaries under HUSKY programs.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-02-01Electronic Spirometry for Home UsePolicy governing prior authorization, medical necessity, and coverage criteria for electronic (home) spirometers for Connecticut Medicaid (HUSKY Health) providers and enrolled patients.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Habilitative Therapy Services (Physical, Occupational, and Speech Therapy) for Individuals Diagnosed with Intellectual Disability/Developmental Delay/Autistic Disorder/Other Developmental DisorderPolicy governing prior authorization, coverage criteria, and procedural requirements for habilitative physical, occupational, and speech therapy for individuals whose primary diagnosis is intellectual disability, developmental delay, autism, or other developmental disorder for HUSKY Health (Connecticut Medicaid) providers.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-12-01Itvisma (onasemnogene abeparvovec-brve) — intrathecal gene therapy coverage criteriaDefines medical necessity, prior authorization requirements, and documentation needed for one-time intrathecal administration of Itvisma for members of the Connecticut HUSKY Health (Medicaid) program aged 2 years and older with confirmed 5q SMA.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-11-01Medical Nutrition Therapy (MNT) Coverage CriteriaGovernance of coverage, prior authorization, provider qualifications, and documentation requirements for Medical Nutrition Therapy (MNT) for HUSKY Health (Connecticut Medicaid) members.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-11-01Radiofrequency ablation for thyroid nodules — Coverage criteriaDefines medical necessity, prior authorization, and coverage criteria for radiofrequency ablation (RFA) of thyroid nodules for HUSKY Health (Connecticut Medicaid) providers.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-08-29KISUNLA (donanemab-azbt) coverage and prior authorizationDefines medical necessity, prior authorization requirements, and coverage criteria for KISUNLA (donanemab-azbt) for treatment of early Alzheimer's disease for HUSKY Health (Connecticut Medicaid) providers.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-08-01Orthognathic (Jaw) Surgery and Associated ProceduresPrior authorization and medical necessity criteria for orthognathic surgery and associated procedures for providers enrolled in the Connecticut Medical Assistance Program (HUSKY Health). Applies to requests for coverage and prior authorization review processes.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-01Temporomandibular joint (TMJ) disorder surgery and associated proceduresDefines medical necessity, prior authorization requirements, and coverage criteria for surgical and associated procedures to treat TMJ disorder for HUSKY Health (Connecticut Medicaid) providers.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-05-01TheraBionic P1 device coverage (coverage criteria)Governs prior authorization and coverage determination for the TheraBionic P1 intrabuccal RF EMF device for Connecticut Medicaid (HUSKY) enrollees; applies to providers requesting coverage under HUSKY A, B, C, and D.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-02-25Lyfgenia (lovotibeglogene autotemcel) — Prior Authorization and Coverage CriteriaPrior authorization policy for one-time administration of Lyfgenia for eligible Connecticut Medicaid (HUSKY Health) members with sickle cell disease; describes medical necessity criteria, required documentation, and procedural requirements for providers.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-02-01Casgevy (exagamglogene autotemcel) gene therapy for sickle cell disease — Prior authorization and medical necessity criteriaPrior authorization and medical necessity criteria for single-dose Casgevy gene therapy in individuals with sickle cell disease covered by HUSKY Health (Connecticut Medicaid). Applies to providers and authorized treatment centers participating in the Connecticut Medical Assistance Program.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-02-01Casgevy (exagamglogene autotemcel) — Beta‑Thalassemia coverage criteriaPrior authorization and medical necessity criteria for single-dose Casgevy gene therapy in individuals aged 12 and older with transfusion-dependent beta-thalassemia covered by HUSKY Health (Connecticut Medicaid). Applies to providers seeking coverage under CMAP.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-02-01Noninvasive pulse oximeter coverage criteriaGoverns prior authorization, clinical criteria, and documentation requirements for noninvasive pulse oximeters provided to HUSKY Health (Connecticut Medicaid) members; affects enrolled CMAP providers requesting coverage for home monitoring devices.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-25Hemgenix (etranacogene dezaparvovec) gene therapy coverage criteriaPrior authorization and medical necessity criteria for one-time Hemgenix gene therapy for adults with severe or moderately severe hemophilia B covered by HUSKY Health (Connecticut Medicaid). Affects providers requesting coverage under the Connecticut Medical Assistance Program (CMAP).All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Certified doula services — coverage criteria (HUSKY Health)Defines coverage, billing, referral, and prior authorization requirements for certified doula services for HUSKY Health members (Connecticut Medicaid) effective January 1, 2025, and explains limits by HUSKY plan type.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Transanal Irrigation (TAI) SystemsGoverns prior authorization, medical necessity criteria, contraindications, and documentation requirements for transanal irrigation systems for HUSKY Health (Connecticut Medicaid) providers.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-11-01Body-powered and Myoelectric Upper Limb ProsthesesDefines medical necessity criteria, prior authorization requirements, documentation, coding, and coverage stance for body-powered and myoelectric upper limb prostheses for Connecticut Medicaid (HUSKY Health) providers.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-11-01PT/INR MONITORSPolicy governing prior authorization, documentation, and coverage criteria for PT/INR monitors and replacements for HUSKY Health (Connecticut Medicaid) members; applies to providers participating in the Connecticut Medical Assistance Program (CMAP).All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-11-01Primary Bariatric Surgery – Coverage Criteria and Prior AuthorizationGoverns prior authorization, medical necessity criteria, and coverage considerations for primary bariatric surgical procedures for HUSKY Health (Connecticut Medicaid) members aged 18 and older; intended for providers requesting authorization. InterQual is used when available; this policy applies when InterQual criteria are not available.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-11-01Ultraviolet B Light Therapy in the Home SettingGoverns prior authorization, medical necessity criteria, and documentation requirements for home ultraviolet B (UVB) phototherapy devices for HUSKY Health (Connecticut Medicaid) members.All husky_health updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-11-01Vision item or service, miscellaneous (HCPCS V2799)Govern prior authorization, medical necessity, coverage, and documentation requirements for miscellaneous vision items and services billed with HCPCS code V2799 for HUSKY Health (Connecticut Medicaid) providers.All husky_health updates
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Tool Description
Search Husky_health 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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