Marylandphysicianscarempc Coverage Criteria
Latest Marylandphysicianscarempc coverage criteria updates7
- Coverage CriteriaClinical/Medical PolicyEff. 2024-01-01Gender-Affirming Care Prior Authorization and Coverage CriteriaDefines Maryland Physicians Care coverage, required documentation, and prior authorization requirements for gender-affirming medical treatments, fertility preservation, and surgeries for members when criteria are met.All marylandphysicianscarempc updates
- Coverage CriteriaClinical/Medical PolicyEff. 2018-07-01Audiology Services and Devices (Hearing Aids, Cochlear Implants, Auditory Osseointegrated Devices)Defines medical necessity, coverage, limitations, and clinical criteria for audiology assessments and devices (hearing aids, cochlear implants, bone-anchored/auditory osseointegrated devices) for Maryland Physicians Care members.All marylandphysicianscarempc updates
- Coverage CriteriaClinical/Medical PolicyAcute Hereditary Angioedema Products: Berinert, Kalbitor, and RuconestDefines prior authorization, coverage criteria, and renewal requirements for Berinert, Kalbitor, and Ruconest for treatment of acute hereditary angioedema (HAE) attacks for Maryland Physicians Care members and providers.All marylandphysicianscarempc updates
- Coverage CriteriaClinical/Medical PolicyAdakveo (crizanlizumab-tmca) — coverage criteria for sickle cell diseasePolicy governs prior authorization and coverage criteria for Adakveo (crizanlizumab-tmca) to reduce vaso-occlusive crises in patients with sickle cell disease aged 16 and older for members of Maryland Physicians Care.All marylandphysicianscarempc updates
- Coverage CriteriaClinical/Medical PolicyAdzynma (ADAMTS13, recombinant-krhn) prior authorizationDefines prior authorization, coverage criteria, dosing, and renewal rules for Adzynma for prophylactic or on‑demand enzyme replacement therapy in pediatric and adult patients with congenital thrombotic thrombocytopenic purpura (cTTP). Applies to prior authorization requests submitted to the payer.All marylandphysicianscarempc updates
- Coverage CriteriaClinical/Medical PolicyAlpha1-Proteinase Inhibitors (Human): Aralast NP, Glassia, Prolastin-C, ZemairaDefines prior authorization, coverage criteria, and renewal requirements for human alpha1-proteinase inhibitor products (Aralast NP, Glassia, Prolastin-C, Zemaira) for treatment of congenital alpha1-antitrypsin deficiency with emphysema for Maryland Physicians Care members and prescribers.All marylandphysicianscarempc updates
- Coverage CriteriaClinical/Medical PolicyExon‑skipping and gene therapy drugs for Duchenne muscular dystrophy (Amondys 45, Elevidys, Exondys 51, Vyondys 53, Viltepso)Prior authorization policy defining coverage criteria, initial and reauthorization requirements, and coding for casimersen, delandistrogene moxeparvovec, eteplirsen, golodirsen, and viltolarsen for treatment of Duchenne muscular dystrophy (DMD). Applies to prescribers and members seeking payer coverage under this Maryland Physicians Care policy.All marylandphysicianscarempc updates
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Tool Description
Search Marylandphysicianscarempc 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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