Security_health_plan_of_wisconsin_inc Coverage Criteria
- Security_health_plan_of_wisconsin_inc prior authorization
- All Security_health_plan_of_wisconsin_inc policy updates
Latest Security_health_plan_of_wisconsin_inc coverage criteria updates21
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Bone Growth Stimulator for the 5th MetatarsalThis policy governs coverage and medical-necessity criteria for noninvasive ultrasonic and electrical bone growth stimulators used for 5th metatarsal fractures. It applies across specified commercial, Medicaid, Medicare Advantage, Family Health Center, and third-party administration products, subject to product-specific benefit documents and authorization requirements.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Lipectomy or Suction-Assisted LipectomyThis policy governs coverage, medical necessity, prior authorization, limitations, and exclusions for lipectomy and suction-assisted lipectomy across applicable Health Plan products. Coverage may apply when specific clinical criteria are met, including treatment of lipedema or breast reconstruction.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-01Peripheral Vascular StentsCoverage and medical-necessity criteria for peripheral arterial, venous, renal, and related vascular stent procedures, including experimental or investigational uses and product-specific limitations.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-02-01TelehealthThis policy governs coverage, clinical criteria, limitations, provider requirements, and billing considerations for telehealth and telemedicine services across Commercial, BadgerCare Plus/Medicaid SSI, Family Health Center, Medicare Advantage, Medicare Supplement, and Third Party Administration products.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Ambulance: Land and Air TransportationThis policy governs coverage, prior authorization, destination requirements, and administrative handling for emergency and non-emergency land ambulance, air/helicopter, and hospital-to-hospital transportation across applicable Health Plan products.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Genetic Testing Oncology: Hereditary CancerCoverage, medical-necessity review, and prior-authorization requirements for genetic testing used to evaluate hereditary cancer susceptibility across Commercial, Medicaid/BadgerCare Plus, Family Health Center, Medicare Advantage, and third-party administration products.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Varicose Vein TreatmentsThis policy governs coverage, medical-necessity review, limitations, exclusions, and site-of-service requirements for varicose vein treatments across Security Health Plan commercial, Medicaid, Family Health Center, Medicare Advantage, and third-party administrator products. Prior authorization is generally not required, but applicable clinical criteria must be met when the claim is submitted.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyAdzynma (recombinant ADAMTS13) for Congenital Thrombotic Thrombocytopenic PurpuraPrior authorization, dosing, coverage criteria, renewal, and billing for intravenous Adzynma in members with severe hereditary ADAMTS13 deficiency and congenital thrombotic thrombocytopenic purpura, including prophylactic and on-demand therapy.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyDecitabineThis policy governs coverage, authorization duration, dosing limits, administration, renewal, and billing for intravenous decitabine in adults with specified hematologic malignancies, including MDS, AML, adult classic Hodgkin lymphoma, BPDCN, accelerated/blast-phase MPN, and MDS/MPN overlap neoplasms.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyHaegarda (C1 Esterase Inhibitor Subcutaneous [Human]) for Hereditary Angioedema ProphylaxisThis policy governs prior authorization, dosing, coverage criteria, renewal, administration, and billing for Haegarda used to prevent hereditary angioedema attacks in patients seeking coverage under Security Health Plan of Wisconsin, Inc.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyKisunla (donanemab-azbt) Intravenous Therapy for Early Alzheimer's DiseaseThis policy governs prior authorization, dosing, renewal, administration, and billing requirements for intravenous Kisunla in adults with mild cognitive impairment due to Alzheimer's disease or mild Alzheimer's dementia. It applies to providers requesting or administering treatment under Security Health Plan of Wisconsin.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyLuxturna (voretigene neparvovec-rzyl) Subretinal InjectionThis policy governs prior authorization, dosing limits, coverage criteria, administration, and billing requirements for Luxturna in patients with biallelic RPE65 mutation-associated retinal dystrophy in Wisconsin.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyPedmark (sodium thiosulfate) Intravenous TherapyThis policy governs prior authorization, dosing, initial coverage, renewal, administration, and billing for intravenous Pedmark used to reduce cisplatin-associated ototoxicity, primarily in pediatric patients with localized, non-metastatic solid tumors.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyPolivy (polatuzumab vedotin-piiq) Intravenous TherapyThis policy governs coverage, authorization duration, dosing, medical necessity criteria, administration, and billing for intravenous Polivy in adults with specified B-cell lymphomas and related hematologic malignancies.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicySaphnelo® (anifrolumab-fnia) Intravenous Therapy for Systemic Lupus ErythematosusGoverns medical necessity, prior authorization, dosing, renewal, administration, and billing requirements for intravenous Saphnelo in systemic lupus erythematosus and other FDA-labeled or compendia-supported indications.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicySkyrizi® (risankizumab-rzaa) IntravenousThis policy governs prior authorization, dosing, and medical necessity criteria for intravenous Skyrizi in adults with moderate to severe active Crohn's disease or ulcerative colitis. It applies to initial induction therapy, which is limited to 3 doses and is not renewable.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicySkysona® (elivaldogene autotemcel) for Cerebral X-Linked AdrenoleukodystrophyThis policy governs prior authorization, medical-necessity criteria, dosing, administration, and billing for Skysona intravenous gene therapy in pediatric male patients with active cerebral X-linked adrenoleukodystrophy (CALD).All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyTezspire® (tezepelumab-ekko) subcutaneous therapyPrior authorization coverage for Tezspire for severe asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), and other FDA-labeled or compendia-supported indications, including medical-necessity criteria, dosing limits, authorization duration, continuation requirements, and concomitant-therapy restrictions.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyTremfya (guselkumab) (Intravenous/Subcutaneous) Coverage CriteriaThis policy governs prior authorization, dosing limits, initial approval, and renewal requirements for intravenous or subcutaneous Tremfya (guselkumab) for plaque psoriasis, adult or juvenile psoriatic arthritis, ulcerative colitis, and Crohn's disease.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyVyepti® (eptinezumab-jjmr) Intravenous Migraine PreventionThis policy governs prior authorization, dosing, renewal, and coverage criteria for intravenous Vyepti used for preventive treatment of migraine in adults. It applies to Security Health Plan of Wisconsin, Inc. non-Medicare coverage determinations, with separate Medicare rules noted in the policy.All security_health_plan_of_wisconsin_inc updates
- Coverage CriteriaClinical/Medical PolicyVyvgart (efgartigimod alfa-fcab) Intravenous Coverage CriteriaThis policy governs prior authorization, dosing, initial approval, and renewal of intravenous Vyvgart, primarily for generalized myasthenia gravis and other FDA-labeled indications, and requires clinical documentation supporting medical necessity.All security_health_plan_of_wisconsin_inc updates
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Tool Description
Search Security_health_plan_of_wisconsin_inc 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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