Moda_health_plan_inc Prior Authorization Lookup
Latest Moda_health_plan_inc prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-08-13Ankle-Foot (AFO)/Knee-Ankle-Foot (KAFO)/Hip-Knee-Ankle-Foot (HKAFO) Orthoses (Custom fabricated)Defines medical necessity, prior authorization requirements, covered and non-covered indications, and coding for custom-fabricated ankle-foot, knee-ankle-foot, and hip-knee-ankle-foot orthoses for Moda Health members.All moda_health_plan_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-13Negative Pressure Wound Therapy (NPWT) (Vacuum-Assisted Wound Closure)Medical necessity and coverage policy for negative pressure wound therapy (vacuum-assisted wound closure) including indications, coverage criteria, coding, and prior authorization documentation requirements for Moda Health Plan Inc members.All moda_health_plan_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-13Panniculectomy (Abdominal skin/fat surgery)This policy defines medical necessity criteria, documentation, and coding for panniculectomy (surgical excision of an abdominal apron/pannus) and explains which related procedures are considered cosmetic and not covered. It applies to Moda Health Plan Inc members and providers requesting prior authorization for panniculectomy.All moda_health_plan_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-13Push-Rim Activated Power-Assist Device (E0986) — Manual Wheelchair AccessoryCoverage policy for push-rim activated power-assist devices (HCPCS E0986) used to convert manual wheelchairs for Moda Health members, defining medical necessity criteria, documentation and prior authorization requirements that affect suppliers and clinicians ordering the device.All moda_health_plan_inc updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-08-07List of CPT/HCPCS codes and investigational/coverage statusThis document lists procedure and supply codes (CPT/HCPCS/temporary G-codes) with short service descriptions and indicates investigational or other coverage designations for Moda Health Commercial Group and Individual Members. It applies to coding/coverage decisions but is only a partial excerpt of a longer policy.All moda_health_plan_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Leuprolide SuspensionDefines Moda Health Plan's medical necessity, dosing limits, prior authorization durations, and indications for leuprolide suspension products for covered members and providers.All moda_health_plan_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Trelstar (triptorelin pamoate) coverage and prior authorization policyDefines prior authorization, dosing limits, indications, and renewal criteria for Trelstar (triptorelin pamoate) for members of Moda Health Plan Inc.; applies to providers requesting coverage for the drug.All moda_health_plan_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Zoladex (goserelin acetate) coverage and prior authorizationDefines prior authorization, dosing limits, indications, renewal and duration rules for Zoladex (goserelin acetate) for members of Moda Health Plan Inc.; applies to providers requesting coverage for the drug.All moda_health_plan_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-02Ranibizumab (Lucentis) and ranibizumab biosimilars (Byooviz, Cimerli, Nufymco)Medical necessity and prior authorization criteria, dosing, coding, and renewal guidance for ranibizumab products and biosimilars for retinal conditions (nAMD, DME, DR, RVO, mCNV) for Moda Health Plan members.All moda_health_plan_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-06-01Continuous Glucose Monitoring (CGM)Defines medical necessity, coverage criteria, prior authorization information, and covered CPT/HCPCS codes for FDA‑approved continuous glucose monitoring systems and related supplies for Moda Health Plan members.All moda_health_plan_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-04-03Transplant prior authorization and related service requirementsDefines prior authorization, notification, and coverage-related requirements for transplant evaluations, transplant events, inpatient admissions, clinical trials, and certain testing for Moda Health Plan Inc members (noting applicability to Texas membership in portions). Affects providers submitting claims and seeking authorization for these services.All moda_health_plan_inc updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-01-012026 Alaska Individual Medical Plan (Moda Select Alaska Silver 4500 AI/AI Zero)This document is the member policy booklet for Moda Health's 2026 Alaska individual medical plan describing benefits, coverage sections, member resources, networks, prior authorization, claims submission, and administrative provisions for subscribers and providers under the Moda Select Alaska Silver 4500 plan.All moda_health_plan_inc updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-01-012026 Alaska Individual Medical Plan (Moda Select Alaska Standard Gold)This document is the Moda Health 2026 Alaska Individual Medical Plan handbook describing benefits, member rights, plan administration, prior authorization requirements, claims submission, and covered services for enrolled members of the Moda Select Alaska Standard Gold AI/AI Zero plan.All moda_health_plan_inc updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-01-012026 Alaska Individual Medical Plan — Moda Select Alaska Bronze 6500 AI/AI ZeroPortions of the Moda Health 2026 Alaska Individual Medical Plan including the cover page, signature/return rights, and an extensive table of contents listing benefits, administrative sections, and prior authorization information; affects subscribers to the Moda Select Alaska Bronze 6500 AI/AI Zero plan.All moda_health_plan_inc updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-01-012026 Alaska Individual Medical Plan — Moda Select Alaska Standard Bronze AI/AI Zero PlanThis document is the Moda Health 2026 Alaska Individual Medical Plan booklet describing member rights, coverage sections, benefits, prior authorization, claims, appeals, and administrative procedures for subscribers to the listed Alaska individual plans.All moda_health_plan_inc updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-01-012026 Alaska Individual Medical Plan — Table of Contents & Introductory NoticeThis document is the Moda Health 2026 Alaska Individual Medical Plan policy materials (Moda Select Alaska Standard Silver AI/AI Zero) including the welcome, refund/cancellation right, authorization signature, and an extensive table of contents outlining member resources, benefits, prior authorization, pharmacy, vision/hearing, claims, and other administrative sections; it applies to subscribers of the referenced 2026 Alaska Individual Medical Plan.All moda_health_plan_inc updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-01-01Idaho Individual Medical Policy (Moda Select Bronze 7500 AI/AN Limited Plan)This document governs covered benefits, exclusions, network and prior authorization policies for the Moda Health Plan Inc Idaho individual medical product (Moda Select Bronze 7500 AI/AN Limited Plan) and related plan materials.All moda_health_plan_inc updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-01-01Idaho Individual Medical Policy (Moda Select Idaho Silver 6400)This document is Moda Health Plan Inc.'s Idaho individual medical policy describing benefits, member resources, networks, prior authorization, and covered services for the Moda Select Idaho Silver 6400 plan; it governs plan terms and operations for members and provider interactions.All moda_health_plan_inc updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-01-01Idaho Individual Medical Policy 2026This document is Moda Health Plan Inc's Idaho Individual Medical Policy (Idaho Individual Medical Policy 2026) describing plan terms, benefits, exclusions, network and prior authorization rules for members of the Moda Select Idaho Bronze 10000 individual plan.All moda_health_plan_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Idaho Individual Medical Policy 2026This document governs the terms, benefits, limitations, and procedures of an individual health insurance policy issued by Moda Health Plan, Inc. for Idaho members (subscriber and dependents) and describes member resources, prior authorization, coverage categories, claims, appeals, and general provisions.All moda_health_plan_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Idaho Individual Medical Policy 2026This document is the individual health insurance policy for Moda Health Plan, Inc. members in Idaho and describes member benefits, limitations, prior authorization, claims, enrollment, and other plan procedures for covered individuals under the specified Idaho individual plan.All moda_health_plan_inc updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-01-01Idaho Individual Medical Policy — Moda Select Idaho Gold 2200 PlanThis document governs benefit structure, member resources, networks, prior authorization, and detailed benefit sections for Idaho individual plan members.All moda_health_plan_inc updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-01-01Idaho Individual Medical Policy — Moda Select Idaho Silver 73% CSR 4000 PlanThis document is the Idaho Individual Medical Policy for Moda Health Plan Inc describing benefits, exclusions, member resources, networks, prior authorization, and coverage sections for the Moda Select Idaho Silver 73% CSR 4000 individual plan; it governs plan terms for enrolled members and administrators.All moda_health_plan_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Idaho Individual Medical Policy — general coverage and exclusionsThis document describes Moda Health Plan Inc.'s individual health coverage for Idaho members, including benefits, limitations, prior authorization, claims, and administrative provisions. It applies to subscribers and dependents enrolled under the Idaho individual policy and to providers administering covered services.All moda_health_plan_inc updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Idaho Individual Medical Policy — general plan terms & preventive servicesThis document is the Moda Health Plan Inc Idaho individual medical policy describing member coverage, benefits, limitations, prior authorization, preventive services, and administrative provisions for enrolled individual members and subscribers.All moda_health_plan_inc updates
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Tool Description
Search Moda_health_plan_incprior 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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