Mediviewcurative Coverage Criteria
Latest Mediviewcurative coverage criteria updates25
- Coverage CriteriaClinical/Medical PolicyEff. 2026-04-28Radiation Therapy Policy (Coverage Criteria for EBRT, SBRT/SRS, PBT, Brachytherapy, SRT)Clinical criteria and coding policy governing medical necessity, prior authorization, and billing for radiation therapy services (multiple modalities) for members of Curative Health Plan in specified states and age groups.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-04-01Behavioral Health and Substance Use Disorder Services (Members 18 and Over)Defines coverage, prior authorization, and medical necessity criteria for behavioral health and substance use disorder services for members aged 18 and older across outpatient, IOP, partial hospitalization, and inpatient settings, including specialized services (ABA, TMS, ECT). Affects providers contracting with Curative Health Plan for applicable products.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-03-04FDA‑approved Gene Therapy Coverage Criteria (Section E)Defines utilization management, coverage criteria, and site/specialist requirements for FDA-approved gene therapy products; affects providers requesting authorization for gene therapies under Curative Health Plan.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-05-05Site of service for covered medical servicesDefines preferred and non-preferred settings for delivering Curative-covered medical and certain pharmacy services and the medical necessity criteria and authorization process that determine when higher-cost settings are appropriate. Applies to all Curative members and providers requesting prior authorization for services.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-04-12External Breast Prosthesis (Mastectomy Bra and Prosthesis) Coverage CriteriaPolicy governing medical necessity and authorization for external breast prostheses and related garments for members following mastectomy, lumpectomy, or for patients with gender dysphoria; used by the Medical Utilization Management department.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-04-12Eyelid and Periorbital Surgery (Blepharoplasty, Ptosis, Brow, Ectropion/Entropion, Tightening) — Coverage CriteriaMedical necessity criteria and authorization guidance for eyelid and periorbital surgical procedures used by the Medical UM Department for Curative Health Plan members.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-04-12Reduction Mammoplasty and Gynecomastia Surgery (Breast Reduction) Coverage CriteriaCriteria and medical necessity guidance for authorization of reduction mammoplasty and gynecomastia surgery for members; applies to Medical Utilization Management reviewers and providers requesting authorization.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-04-12Urinary Incontinence: Diagnostic Testing and InterventionsDefines medical necessity criteria for diagnostic testing and a range of interventions for urinary incontinence for members under the Medical UM Department.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-04-12Voice Therapy — Medical Necessity and Coverage CriteriaPolicy governing medical necessity decisions for authorization requests for voice therapy services for members managed by the Medical Utilization Management (UM) Department.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-04-01Wheelchairs and Power Operated Vehicles (Scooters) Coverage CriteriaClinical policy governing medical necessity, authorization, and coverage criteria for manual wheelchairs, power wheelchairs, power operated vehicles (scooters), wheelchair seating systems, and related options/accessories for plan members.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-03-22Bariatric Surgery Medical Necessity and Preoperative RequirementsDefines medical necessity criteria, preoperative requirements, and covered bariatric procedures for Curative Health Plan members; applies to Medical UM Department reviewers and providers requesting authorization for bariatric surgery.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-03-22Experimental, Investigational and Emerging TechnologyDefines how Curative determines and manages services considered experimental or investigational for medical and pharmacy utilization management; applies to the Medical and Pharmacy UM Departments and delegated entities.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-12-01Diagnosis and Medical Management of Sleep ApneaDefines clinical criteria and testing requirements for diagnosing and medically managing obstructive sleep apnea (OSA), including attended in-lab polysomnography and unattended home sleep testing; applies to members of the Curative Health Plan (adults and pediatric references included).All mediviewcurative updates
- Coverage CriteriaEff. 2023-12-01Heart transplantation medical necessity criteria and technology positionsDefines Curative Health Plan's medical necessity, selection criteria, contraindications, and related coverage positions for human heart transplantation and certain related technologies; intended for use by the Medical Utilization Management (UM) department.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-12-01Kidney Transplantation — Medical Necessity and Coverage CriteriaDefines medical necessity criteria, requirements, and coverage positions for kidney transplantation and related procedures for use by the Medical Utilization Management department.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-12-01Liver Transplantation — Medical Necessity and Coverage CriteriaMedical necessity criteria and requirements for liver transplantation evaluations and coverage determinations for members undergoing liver transplant or retransplant procedures, intended for the Medical Utilization Management department.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-12-01Multiple Sclerosis medications (brand selection) including Lemtrada, Ocrevus, Mitoxantrone, IV steroidsThis policy governs medical and pharmacy utilization management (precertification and coverage criteria) for multiple sclerosis (MS) therapies for Curative Health Plan members and participating providers.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-12-01Testosterone Replacement Therapy (injectable and pellets)Defines medical necessity criteria and utilization management requirements for injectable testosterone and Testopel (testosterone pellets) for members receiving pharmacy or medical benefits under the plan.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-12-01Ventricular Assist Device (VAD) Coverage PolicyDefines medical necessity criteria and requirements for coverage of ventricular assist devices (including LVAD, RVAD, pVAD, pediatric VADs, and Impella RP) for use by the Medical Utilization Management department.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-12-01Viscosupplementation for knee osteoarthritis (coverage criteria)This policy governs prior-approval, medical necessity, and coverage criteria for intra-articular viscosupplementation (hyaluronates) for knee osteoarthritis for Curative Health Plan participating providers and members.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-11-01Applied Behavioral Analysis (ABA) TherapyThis policy governs precertification, documentation, and medical necessity criteria for outpatient ABA services for members with Autism Spectrum Disorder (ASD) and is intended for use by the Medical Utilization Management department and participating providers.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-11-01Electroconvulsive Therapy (ECT) Coverage CriteriaPolicy governing review, approval, and coverage criteria for Electroconvulsive Therapy (ECT), including required consent and limits on initial and subsequent treatment sessions for members under Curative Health Plan; references Texas law for consent requirements.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-10-16Colonoscopy and Colorectal ScreeningClinical policy governing medical necessity and coverage criteria for colorectal cancer screening, surveillance, and diagnostic colonoscopy-related procedures for members managed by the Medical UM Department.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-10-01Cardiac Event Monitors PolicyClinical policy governing medical necessity and coverage criteria for external intermittent event monitors, mobile cardiovascular telemetry, implantable loop recorders, and long-term external ECG monitoring for Curative Health Plan; applies to Medical UM Department processes and providers requesting these services.All mediviewcurative updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-10-01Chiropractic Services PolicyPolicy governing coverage and medical necessity criteria for chiropractic services for Curative Health Plan PPO+ members; applies to Medical Utilization Management staff and providers requesting coverage.All mediviewcurative updates
1–25 of 69
1 / 3
Tool Description
Search Mediviewcurative 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.