Medstarfamilychoicemaryland Prior Authorization Lookup
Latest Medstarfamilychoicemaryland prior authorization updates13
- Prior AuthAdministrative/Operational PolicyEff. 2026-07-01Pharmacy Authorization ProcessGoverns how medication authorization requests are received, evaluated, decided, and communicated for members, prescribers, dispensing pharmacies, preauthorization staff, and Medical Reviewers.All medstarfamilychoicemaryland updates
- Prior AuthClinical/Medical PolicyEff. 2025-07-01Biomarkers for Companion Diagnostic Testing & Targeted Drug TherapyThis policy governs MedStar Family Choice coverage and prior authorization for biomarker testing used to guide FDA-approved targeted cancer treatments. It applies to providers requesting testing for members with an established cancer diagnosis or clinically substantiated suspicion of cancer.All medstarfamilychoicemaryland updates
- Prior AuthAdministrative/Operational PolicyEff. 2025-07-01Pharmacy Authorization ProcessGoverns how medication authorization requests for non-formulary or prior-authorization medications are received, evaluated, decided, and communicated.All medstarfamilychoicemaryland updates
- Prior AuthClinical/Medical PolicyEff. 2023-08-01Biomarkers for Companion Diagnostic Testing & Targeted Drug TherapyCoverage and prior authorization for biomarker testing used as a companion diagnostic to direct specific cancer treatments for Maryland Medicaid members in Maryland.All medstarfamilychoicemaryland updates
- Prior AuthClinical/Medical PolicyEff. 2011-10-01INTERSTIM for Fecal IncontinenceThis policy governs prior authorization for INTERSTIM implantable sacral nerve stimulation therapy for chronic fecal incontinence in MedStar Family Choice members in Maryland. Coverage requires the member to meet the documented clinical criteria and applies to appropriate surgical candidates.All medstarfamilychoicemaryland updates
- Prior AuthClinical/Medical PolicyClinical Criteria for Hepatitis C (HCV) TherapyThis policy governs prior authorization for hepatitis C antiviral therapy, including treatment-naive and treatment-experienced patients, pediatric patients, patients with cirrhosis, and recipients of non-liver organs from HCV-viremic donors.All medstarfamilychoicemaryland updates
- Prior AuthClinical/Medical PolicyFertility Preservation ServicesThis policy governs when MedStar Family Choice may approve fertility preservation procedures for members whose medically necessary treatment may directly or indirectly cause iatrogenic infertility. All fertility preservation services require prior authorization and medical director review.All medstarfamilychoicemaryland updates
- Prior AuthClinical/Medical PolicyHigh-Cost Medication Prior Authorization CriteriaThis policy governs prior authorization, initial approval, renewal, documentation, dosing, quantity, and duration requirements for high-cost medications covered by MedStar Family Choice.All medstarfamilychoicemaryland updates
- Prior AuthClinical/Medical PolicyMedical Drug Benefit PolicyEstablishes medical necessity, prior authorization, utilization management, formulary, biosimilar, continuation-of-therapy, and site-of-care requirements for provider-administered drugs covered under the medical benefit.All medstarfamilychoicemaryland updates
- Prior AuthClinical/Medical PolicyNon-Invasive Prenatal Aneuploidy and Other Prenatal Genetic TestingThis policy governs coverage and authorization requirements for non-invasive prenatal screening for fetal aneuploidy and other prenatal genetic testing in Maryland. Routine screening for trisomies 13, 18, and 21 is available without prior authorization under specified conditions; testing beyond those screens requires prior authorization.All medstarfamilychoicemaryland updates
- Prior AuthClinical/Medical PolicyOpioid Prescription Prior AuthorizationThis policy governs evaluation and prior authorization of opioid medication requests for MedStar Family Choice Maryland members. It establishes utilization, safety, documentation, exemption, denial, and prescriber-network requirements for opioid coverage.All medstarfamilychoicemaryland updates
- Prior AuthClinical/Medical PolicyOpioid Prescription Prior AuthorizationThis policy governs MedStar Family Choice Maryland’s evaluation and authorization of opioid prescriptions for Medicaid managed care members. It establishes automated and Medical Reviewer requirements, documentation and safety attestations, exceptions, denial conditions, and limits for opioid therapy.All medstarfamilychoicemaryland updates
- Prior AuthClinical/Medical PolicyUtilization Management (UM) CriteriaThis policy governs the criteria and processes MedStar Family Choice uses to make utilization management decisions for Maryland members, including preauthorization, retrospective review, concurrent review, pharmacy requests, emergency care, and requests for UM criteria.All medstarfamilychoicemaryland updates
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Tool Description
Search Medstarfamilychoicemarylandprior 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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