Medstarfamilychoicemaryland Coverage Criteria
Latest Medstarfamilychoicemaryland coverage criteria updates6
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01External Insulin PumpsCoverage criteria, authorization, documentation, continued coverage, exclusions, and benefit routing for external insulin pumps used by Maryland members with Type 1 or Type 2 diabetes.All medstarfamilychoicemaryland updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-01Hearing Aid CoverageThis policy governs medical-necessity coverage and authorization of hearing aids, auditory osseointegrated or bone-anchored hearing devices, and related audiology services for MedStar Family Choice Maryland members with hearing loss. It establishes age-specific clinical criteria, documentation requirements, acceptable devices and services, and exclusions.All medstarfamilychoicemaryland updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-07-01Back Brace Coverage Medical Non-Pharmacy ProtocolsThis policy governs when MedStar Family Choice utilization management staff may authorize payment for back braces for members in Maryland. It applies to back brace requests submitted through in-network providers or in-network durable medical equipment vendors and establishes coverage criteria, limitations, and medical exception review.All medstarfamilychoicemaryland updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-07-01Custom Compression Garments for Diagnoses Excluding LymphedemaCoverage criteria for authorizing custom-fabricated compression garments and Maryland Medicaid Fee Schedule garments designated as “I/C” for members with non-lymphedema diagnoses.All medstarfamilychoicemaryland updates
- Coverage CriteriaClinical/Medical PolicyEff. 2011-10-01INTERSTIM for Fecal IncontinenceThis policy governs prior authorization for INTERSTIM implantable sacral nerve stimulation therapy for chronic fecal incontinence in MedStar Family Choice members in Maryland. Coverage requires the member to meet the documented clinical criteria and applies to appropriate surgical candidates.All medstarfamilychoicemaryland updates
- Coverage CriteriaClinical/Medical PolicyClinical Criteria for Hepatitis C (HCV) TherapyThis policy governs prior authorization for hepatitis C antiviral therapy, including treatment-naive and treatment-experienced patients, pediatric patients, patients with cirrhosis, and recipients of non-liver organs from HCV-viremic donors.All medstarfamilychoicemaryland updates
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Search Medstarfamilychoicemaryland 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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