Curative Prior Authorization Lookup
Latest Curative prior authorization updates25
- Prior AuthClinical/Medical Policy34. Surgery - ContraceptiveThis policy governs coverage and clinical review for female sterilization, IUD insertion, removal, or replacement, bilateral salpingectomy when performed for contraception, and vasectomy when included in the member's benefit. It applies to all ages unless a specific federal or state consent rule applies to the funding source, and evaluates the elected method, consent, documentation, and applicable benefit rules.All curative updates
- Prior AuthClinical/Medical Policy71. DME - Gradient Compression Garments for Lymphedema (HCPCS A6549)This policy governs medical-necessity, documentation, coding, quantity, and replacement requirements for gradient compression garments and related lymphedema compression treatment items, including HCPCS A6549, for members of all ages.All curative updates
- Prior AuthClinical/Medical Policy82. DME - Surgical Implants (Durable)Medical-necessity criteria for implantable devices, separately reported implant supplies, durable implant components, and replacement or external components not governed by a device-specific policy.All curative updates
- Prior AuthClinical/Medical PolicyA003. Acute Heart Failure / Heart Failure ExacerbationThis policy governs medical necessity for acute inpatient admission, observation or outpatient management, level-of-care assignment, continued stay, and discharge readiness for adults with new-onset acute heart failure or acute decompensation of chronic heart failure, including heart-failure-related cardiogenic shock. It applies to Curative commercial PPO and EPO members in fully insured, level-funded, and self-funded plans.All curative updates
- Prior AuthClinical/Medical PolicyA047. RhabdomyolysisThis policy governs medical necessity for acute inpatient admission, observation or outpatient management, ICU and intermediate-level placement, medical-surgical care, continued stay, and discharge readiness for Curative commercial PPO and EPO members with rhabdomyolysis. It applies to all ages and covers rhabdomyolysis caused by exertion, trauma, drugs or toxins, seizures, heat illness, infection, or metabolic causes.All curative updates
- Prior AuthClinical/Medical PolicyA049. Adrenal Crisis and Acute Adrenal InsufficiencyMedical-necessity criteria for acute inpatient admission, level-of-care assignment, continued stay, and discharge readiness for Curative commercial PPO and EPO members with adrenal crisis or acute decompensated adrenal insufficiency across all ages.All curative updates
- Prior AuthClinical/Medical PolicyA061. Hip Fracture — Acute Inpatient Management of Closed Proximal Femur FracturesGoverns acute inpatient admission, level of care, continued stay, and discharge readiness for Curative commercial members with closed proximal femur fractures treated surgically or, in selected cases, nonoperatively.All curative updates
- Prior AuthClinical/Medical PolicyA070. Delirium and Acute Altered Mental StatusMedical-necessity criteria for acute inpatient admission, observation, level of care, continued stay, and discharge readiness for adults with delirium or acute altered mental status caused by medical, metabolic, or toxic conditions across Curative commercial plans.All curative updates
- Prior AuthClinical/Medical PolicyADAMTS13 Testing for Thrombotic Thrombocytopenic PurpuraThis policy governs medical-necessity review of ADAMTS13 activity, ADAMTS13 inhibitor, and anti-ADAMTS13 antibody testing for suspected or established immune-mediated or congenital TTP in all ages. It applies to outpatient laboratory testing and excludes inpatient thrombotic microangiopathy management, plasma exchange, caplacizumab, recombinant ADAMTS13, and germline ADAMTS13 sequencing.All curative updates
- Prior AuthClinical/Medical PolicyAbdominal Aortic Aneurysm Repair (Open and Endovascular)Curative commercial PPO and EPO coverage for inpatient admission, level-of-care assignment, continued stay, and discharge after open or endovascular repair of abdominal aortic aneurysms and associated abdominal aortic dissection repair in adults age 18 and older.All curative updates
- Prior AuthClinical/Medical PolicyAbdominoperineal Resection (APR)This policy governs medical necessity, inpatient level of care, continued stay, discharge readiness, and documentation for open, laparoscopic, or robotic abdominoperineal resection with permanent end colostomy and perineal closure or flap reconstruction in adults 18 years and older.All curative updates
- Prior AuthClinical/Medical PolicyAblative Procedures for Prostate CancerThis policy establishes medical-necessity and prior-authorization criteria for whole-gland and partial-gland ablation of prostate cancer, including primary treatment of localized disease and salvage treatment after radiotherapy. It applies to adults 18 years and older and addresses cryoablation, HIFU, facility requirements, repeat treatment, investigational techniques, documentation, coding, and review authority.All curative updates
- Prior AuthClinical/Medical PolicyAcute Aortic Syndrome Inpatient Admission and Level-of-Care ManagementMedical necessity criteria for acute inpatient admission, ICU and ward level-of-care assignment, continued stay, discharge readiness, and emergency repair or TEVAR for Curative commercial PPO and EPO members with acute aortic syndromes.All curative updates
- Prior AuthClinical/Medical PolicyAcute Appendicitis — Inpatient and Level-of-Care ManagementThis policy governs acute inpatient admission, observation, outpatient management, ICU and intermediate-care placement, continued stay, and discharge readiness for Curative commercial members with suspected or confirmed acute appendicitis. Elective interval appendectomy is outside scope.All curative updates
- Prior AuthClinical/Medical PolicyAcute Compartment SyndromeMedical-necessity criteria for acute inpatient admission, observation, level of care, continued stay, discharge readiness, and related services for Curative commercial members with suspected or confirmed acute compartment syndrome of the extremities; pediatric cases are reviewed with pediatric orthopedic input.All curative updates
- Prior AuthClinical/Medical PolicyAcute Exacerbation of Chronic Obstructive Pulmonary DiseaseMedical-necessity criteria for outpatient treatment, observation, acute inpatient admission, level-of-care assignment, continued stay, and discharge readiness for Curative commercial members age 18 and older with acute COPD exacerbation, including acute hypercapnic respiratory failure treated with noninvasive or invasive ventilation.All curative updates
- Prior AuthClinical/Medical PolicyAcute Graft-Versus-Host DiseaseThis policy governs inpatient admission, level of care, continued stay, and discharge readiness for acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation, including steroid-refractory disease. It applies to Curative commercial PPO and EPO members in fully insured, level-funded, and self-funded plans; drug coverage is determined under applicable drug policies.All curative updates
- Prior AuthClinical/Medical PolicyAcute Heat Stroke Inpatient and Level-of-Care Coverage PolicyMedical-necessity criteria for acute inpatient admission, observation, outpatient management, intensive care, intermediate care, medical-surgical care, continued stay, and discharge readiness for exertional and classic heat stroke in Curative commercial members of all ages.All curative updates
- Prior AuthClinical/Medical PolicyAcute Inpatient Hospital Facility Admission and StayEstablishes medical-necessity criteria for acute inpatient hospital admission, continued stay, discharge, and transition for medical and surgical conditions in acute care hospitals for members of all ages.All curative updates
- Prior AuthClinical/Medical PolicyAcute Inpatient Management of Open FracturesGoverns acute inpatient admission, level of care, continued stay, and discharge readiness for Curative commercial PPO and EPO members of all ages with open fractures of the extremities and pelvis caused by blunt or penetrating trauma.All curative updates
- Prior AuthClinical/Medical PolicyAcute Inpatient SplenectomyThis policy governs medical necessity and acute inpatient level-of-care coverage for open or laparoscopic total or partial splenectomy for trauma, hematologic disease, abscess or infarction, and splenic neoplasm. It applies to all ages, with pediatric trauma and elective pediatric considerations noted in the policy.All curative updates
- Prior AuthClinical/Medical PolicyAcute Inpatient and Level-of-Care Management for Cauda Equina SyndromeThis policy governs medical necessity for acute inpatient admission, observation or outpatient disposition, level-of-care assignment, continued stay, and discharge readiness for adults with suspected or confirmed cauda equina syndrome from compressive causes. It applies to Curative commercial PPO and EPO members; pediatric members are reviewed under the same framework.All curative updates
- Prior AuthClinical/Medical PolicyAcute Kidney InjuryThis policy governs medical necessity for acute inpatient admission, observation versus outpatient management, level-of-care assignment, continued stay, discharge readiness, and related services for members with acute kidney injury, including AKI superimposed on chronic kidney disease. It applies to Curative commercial PPO and EPO members in fully insured, level-funded, and self-funded plans.All curative updates
- Prior AuthClinical/Medical PolicyAcute Myocardial Infarction - NSTEMI / Unstable AnginaThis policy governs medical necessity for acute inpatient admission, observation or outpatient management, level-of-care assignment, continued stay, and discharge readiness for adults with NSTEMI, type 2 myocardial infarction, unstable angina, or acute chest pain undergoing evaluation for acute coronary syndrome. It applies to Curative commercial PPO and EPO members in fully insured, level-funded, and self-funded plans.All curative updates
- Prior AuthClinical/Medical PolicyAcute Myocarditis Inpatient CareMedical-necessity criteria for acute inpatient admission, observation, level-of-care assignment, continued stay, and discharge readiness for Curative commercial PPO and EPO members with suspected or confirmed acute myocarditis.All curative updates
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Tool Description
Search Curativeprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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