Orthonet Coverage Criteria
Latest Orthonet coverage criteria updates5
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-04ReActiv8 Implantable Neurostimulation System — Coverage CriteriaDefines OrthoNet's coverage stance and evidence assessment for the ReActiv8 restorative neurostimulation system used to treat chronic mechanical low back pain associated with multifidus muscle dysfunction; applies to medical necessity determinations for members receiving this device.All orthonet updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-04-30Electrodiagnostic Testing (EDX) — NCV/NCS, Needle EMG, SSEPClinical criteria governing the appropriate use and medical necessity of electrodiagnostic testing (NCV/NCS, needle EMG, SSEP) for evaluation of neuromuscular disorders; applies to in- and out-of-network programs (excludes Medicare/Medicaid chiropractic products).All orthonet updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-04-30Extraspinal Manual Therapy InterventionsDefines coverage and medical necessity criteria for manipulation or mobilization of extremity joints (extraspinal) for musculoskeletal disorders for in- and out-of-network programs (excluding certain products). Applies to providers requesting utilization review determinations.All orthonet updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-12Clinical Criteria used for Pain and Spine Utilization ManagementDefines the clinical criteria and reference sources OrthoNet uses to guide utilization management decisions for pain and spine services for members and providers.All orthonet updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Clinical Criteria for Pain and Spine Utilization ManagementDefines the clinical criteria and reference guidelines OrthoNet uses to make utilization management decisions for pain and spine services across member health plans; affects providers requesting pain and spine procedures for OrthoNet members.All orthonet updates
Tool Description
Search Orthonet 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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