Medstarfamilychoicedistrictofcolumbia Prior Authorization Lookup
- Medstarfamilychoicedistrictofcolumbia coverage criteria
- All Medstarfamilychoicedistrictofcolumbia policy updates
Latest Medstarfamilychoicedistrictofcolumbia prior authorization updates16
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Preferred Viscosupplementation Products for Knee OsteoarthritisDefines preferred viscosupplementation products for treatment of knee osteoarthritis and prior authorization requirements for MedStar Family Choice District of Columbia providers effective for dates of service on or after May 1, 2026.All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthClinical/Medical PolicyEff. 2026-05-01Viscosupplementation for Knee OsteoarthritisThis policy governs medical necessity, coverage, and prior authorization requirements for intra-articular hyaluronic acid (viscosupplementation) injections for members with knee osteoarthritis enrolled in MedStar Family Choice District of Columbia.All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthEff. 2025-09-01Private Duty Nursing Care (PDN) — Coverage and Prior AuthorizationDefines MedStar Family Choice District of Columbia criteria and procedures for prior authorization, coverage, and limitations of hourly RN and LPN private duty nursing (PDN) services for members.All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthAdministrative/Operational PolicyEff. 2024-10-01PCP referral requirement for in-network specialistsAnnounces that MedStar Family Choice DC enrollees no longer need a PCP written referral to see in-network specialists; applies to MFC-DC providers and enrollees. Out-of-network specialist visits still require a written referral plus prior authorization.All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthClinical/Medical PolicyEff. 2022-03-01Coverage for Noninvasive Prenatal Testing (NIPT)This alert announces that MedStar Family Choice District of Columbia (MFC-DC) and the District's Department of Health Care Finance (DHCF) now cover and reimburse noninvasive prenatal testing (NIPT) for pregnant women; it applies to providers submitting claims to MFC-DC. Specified NIPT CPT codes do not require prior authorization.All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthClinical/Medical PolicyEff. 2020-10-01Compression Garments for LymphedemaDefines medical necessity criteria and prior authorization requirements for custom and manually-priced compression garments for treatment of lymphedema for MedStar Family Choice District of Columbia enrollees.All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthClinical/Medical PolicyEff. 2020-10-01Custom-Fabricated Compression Garments (excluding lymphedema)Defines medical necessity and prior authorization requirements for custom compression garments and items on the DC Medicaid Fee Schedule designated as 'Manual Pricing' for MedStar Family Choice DC enrollees (excluding lymphedema covered under a separate policy).All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthClinical/Medical PolicyEff. 2020-10-01INTERSTIM sacral nerve stimulation for fecal incontinenceGoverns prior authorization and coverage criteria for INTERSTIM implantable sacral nerve stimulation to treat chronic fecal incontinence for MedStar Family Choice District of Columbia enrollees.All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthClinical/Medical PolicyEff. 2020-10-01Opioid Prescription Prior AuthorizationDefines MedStar Family Choice DC requirements for prior authorization of opioid prescriptions, including limits, exemptions, documentation, and review processes for enrolled members and providers.All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthClinical/Medical PolicyEff. 2020-10-01Personal Care Assistant (PCA) ServicesDefines conditions under which MedStar Family Choice District of Columbia may authorize PCA services for eligible DC Healthy Families enrollees; specifies prior authorization, documentation, and service limits. Does not cover DC Healthcare Alliance enrollees. All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthClinical/Medical PolicyEff. 2020-10-01Pharmacy Authorization Process (Prior Authorization and Non-Formulary Medication Process)Defines MedStar Family Choice DC's process for evaluating and processing pharmacy prior authorization, non-formulary, urgent, and retrospective medication requests for Enrollees and providers.All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthClinical/Medical PolicyEff. 2020-10-01Pharmacy Benefits Management (Formulary and Utilization Management)Defines MedStar Family Choice DC's processes for managing the closed formulary, utilization management (prior authorization, step therapy, quantity limits), communication of formulary changes, and responsibilities of the P&T Committee; applies to MedStar Family Choice District of Columbia enrollees and providers.All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthEff. 2020-10-01Pneumatic Compression Devices for Chronic Venous InsufficiencyDefines medical necessity criteria and prior authorization requirements for providing pneumatic compression devices to MedStar Family Choice District of Columbia enrollees with chronic venous insufficiency (CVI), including documentation and provider requirements.All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthClinical/Medical PolicyEff. 2020-10-01Pneumatic Compression Devices for LymphedemaDefines coverage, prior authorization, and medical necessity criteria for pneumatic compression devices for MedStar Family Choice District of Columbia enrollees with lymphedema.All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthClinical/Medical PolicyEff. 2020-10-01Utilization Management (UM) Criteria — Clinical OperationsDefines MedStar Family Choice District of Columbia's utilization management criteria, processes, and timelines for prior authorization, concurrent review, pharmacy, emergency care, and related UM workflows; applicable to providers submitting authorization and retrospective requests for MedStar Family Choice DC enrollees.All medstarfamilychoicedistrictofcolumbia updates
- Prior AuthAdministrative/Operational PolicyUtilization review and pharmacy prior authorization reportingThis document provides aggregated requirements and performance metrics for prior authorization requests and appeals for MedStar Family Choice District of Columbia affecting relevant providers (e.g., Family Medicine, Pediatrics, Obstetrics/Gynecology, Emergency Medicine, Registered Pharmacists).All medstarfamilychoicedistrictofcolumbia updates
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Tool Description
Search Medstarfamilychoicedistrictofcolumbiaprior 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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Prior auth requirements change all the time. Keep up with every payer policy update in the live policy feed, or browse payers with prior authorization policies.
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