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.