View Medical Policies

For certain member contracts, the Health Plan has delegated utilization management of the following services to eviCore Healthcare MSI, LLC d/b/a eviCore Healthcare: implantable cardiac devices, radiology/imaging, radiation therapy, and musculoskeletal services (large joint replacement, pain management, and spine services). The Health Plan has adopted eviCore’s medical policies and guidelines as a basis for the determination of medical necessity and appropriateness of care.

Please refer member-specific questions to the Customer Care number on the back of the member card. Final determination of coverage is subject to the member’s benefits and eligibility on the date of service.

Showing 301– 306 of 306 Results
Title Last Updated Category
Genetic Testing for Familial Alzheimer's Disease Open a PDF 2.02.16 2024-05-30 Genetic Disease (Inherited Disease)
Bioimpedance Devices for Detection and Management of Lymphedema Open a PDF 2.01.52 2024-05-30 Miscellaneous
Evoked Potentials Open a PDF 2.01.27 2024-05-30 Nervous Systems (Neurology)
Hyperbaric Oxygen Therapy (HBOT) Open a PDF 2.01.07 2024-05-30 Miscellaneous
Lumbar Traction: Vertebral Axial Decompression and Home Lumbar Traction Devices Open a PDF 1.01.50 2024-05-30 Bone & Joints (Orthopedic)
Continuous Glucose Monitoring Systems/External Insulin Pump Therapy for Diabetes Open a PDF 1.01.30 2024-05-30 Diabetes (Endocrinology)
Showing 301– 306 of 306 Results


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