Lucet Coverage Criteria
Latest Lucet coverage criteria updates12
- Coverage CriteriaClinical/Medical PolicyEff. 2025-02-01Transcranial Magnetic Stimulation (TMS) for Major DepressionPolicy governing coverage and medical necessity criteria for transcranial magnetic stimulation (TMS) to treat major depressive disorder, including training requirements, eligible patient criteria, treatment protocols, exclusions, and coding guidance for providers and clinics seeking authorization.All lucet updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-08-21Electroconvulsive Therapy (ECT) - 2024Defines medical necessity, authorization, and clinical requirements for ECT benefit approval for Lucet members and providers during plan year 2024.All lucet updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-01-01Psychological and Neuropsychological Testing CriteriaDefines medical necessity criteria, limitations, and expectations for psychological and neuropsychological testing for members covered under Lucet plans; applies to providers requesting or performing these assessments.All lucet updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-01-01Psychological and Neuropsychological Testing Criteria - 2024Defines authorization parameters and medical necessity criteria for psychological and neuropsychological testing for Lucet members for plan year 2024, including requirements for test administration, provider qualifications, and documentation for initial authorization.All lucet updates
- Coverage CriteriaClinical/Medical PolicyEff. 2021-08-01Electroconvulsive Therapy (ECT)Medical necessity and coverage criteria for initial, continuation, and maintenance electroconvulsive therapy (ECT) for members whose benefits include ECT. Applies to providers requesting authorization for ECT services.All lucet updates
- Coverage CriteriaClinical/Medical PolicyEff. 2021-08-01Electroconvulsive Therapy (ECT) — Coverage CriteriaPolicy governing medical necessity, authorization criteria, and expectations for ECT (initial, continuation, and maintenance) for members whose benefits include ECT; applies to providers requesting coverage.All lucet updates
- Coverage CriteriaClinical/Medical PolicyEff. 2017-01-01Applied Behavior Analysis for the Treatment of Autism Spectrum Disorder (Federal Employees)Policy governing medical necessity, coverage criteria, and authorization requirements for ABA treatment of members with Autism Spectrum Disorder under the Federal Employees Service Benefit Plan managed by Lucet Behavioral Health.All lucet updates
- Coverage CriteriaClinical/Medical PolicyEff. 2017-01-01Applied Behavior Analysis for the Treatment of Autism Spectrum Disorder (Federal Employees)Defines medical necessity, coverage criteria, service intensity, assessment and documentation requirements for ABA services for Service Benefit Plan federal employees diagnosed with Autism Spectrum Disorder; applies to providers managing ABA benefits in specified Service Benefit Plan locations.All lucet updates
- Coverage CriteriaClinical/Medical PolicyEff. 2017-01-01Applied Behavior Analysis for the Treatment of Down SyndromeDefines Lucet's coverage policy, medical necessity criteria, and authorization requirements for Applied Behavior Analysis (ABA) services provided to members diagnosed with Down syndrome (without comorbid ASD). Applies to providers seeking ABA benefit determinations under Lucet-managed plans.All lucet updates
- Coverage CriteriaClinical/Medical PolicyEff. 2014-10-01Transcranial Magnetic Stimulation for the Treatment of Major DepressionPolicy governing coverage and medical necessity criteria for repetitive TMS treatment of treatment‑resistant major depressive disorder for Lucet members and participating providers.All lucet updates
- Coverage CriteriaClinical/Medical PolicyContinuation and Maintenance Outpatient Electroconvulsive Therapy (ECT) Coverage CriteriaThis form and policy govern requests for continuation and maintenance outpatient ECT, describing required documentation, clinical criteria, and billing units for Lucet-covered members. It applies to providers requesting authorization or submitting continuation/maintenance ECT requests for covered members.All lucet updates
- Coverage CriteriaClinical/Medical PolicyREQUEST FOR CONTINUATION OR MAINTENANCE OUTPATIENT ELECTROCONVULSIVE THERAPY (ECT)Form and coverage criteria for continuation and maintenance outpatient ECT, including required clinician assessments, patient response/intolerance criteria, consent, and billing units/codes. Applies to requests for continuation or maintenance outpatient ECT; includes instructions for submission and lists CPT codes and unit limits.All lucet updates
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Tool Description
Search Lucet 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
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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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