Quartz Coverage Criteria
Latest Quartz coverage criteria updates4
- Coverage CriteriaClinical/Medical PolicyEff. 2024-07-01Infliximab Products Clinical Resource — Coverage and Medical NecessityDefines coverage stance, medical necessity criteria, and supported/unsupported indications for branded and biosimilar infliximab products for Quartz members and providers.All quartz updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-02-01Filgrastim Products (Neupogen, biosimilars, tbo‑filgrastim) — Coverage CriteriaGuidance on clinical use and prior authorization requirements for filgrastim products (Neupogen and biosimilars, plus tbo-filgrastim) for members of Quartz Health Benefit Plans; specifies indications, dosing durations, and when prior authorization is required.All quartz updates
- Coverage CriteriaClinical/Medical PolicyEff. 2022-09-01Bevacizumab Products Clinical Resource (coverage criteria)Defines Quartz's coverage stance, clinical considerations, and prior authorization requirements for bevacizumab (brand and biosimilars) across oncologic and ophthalmic indications for members covered by Quartz plans.All quartz updates
- Coverage CriteriaClinical/Medical PolicyEff. 2022-09-01Hyaluronic Acid Derivatives — Clinical Coverage Guidance for Knee OsteoarthritisClinical coverage guidance for intraarticular hyaluronic acid derivative products used to treat knee osteoarthritis for Quartz members; indicates which products require prior authorization and sets medical necessity criteria and dosing. Affects ordering/administration by physicians in rheumatology, orthopedics, and physical medicine/rehabilitation.All quartz updates
Tool Description
Search Quartz 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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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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