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Medicare Policies
The following rules apply to Medicare:
Annual Wellness Visit Billing Guidelines
For a list of services requiring prior authorization, click on this link, PA list.
For Medicare coverage criteria, the following applies:
- National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs) CMS coverage database
- Published guidance from the Centers for Medicare and Medicaid Services (CMS), including the Medicare Benefit Policy Manual, and MLN Matters publications.
NOTE: Only items listed in the Prior Authorization (PA) lists require prior authorization.
See Medicare products and additional items/services covered beyond Medicare