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Clinical Coverage Criteria References

When Medicare does not fully define coverage for a service through statute, regulation, National Coverage Determinations, or Local Coverage Determinations, we use clinical coverage criteria based on current evidence, treatment guidelines, and clinical literature. These criteria comply with CMS requirements and are publicly available.

Total EasyCare Plus EasyCare
Acupuncture Authorization Guideline
Download PDF:
Total EasyCare Plus EasyCare
Total EasyCare Plus EasyCare
Dental Services (Coming Soon)
Total EasyCare Plus EasyCare
Medical Necessity and Other Clinical Coverage Criteria (Coming Soon)
EasyCare Total EasyCare Plus
Outpatient Physical, Occupational, and Speech Therapy Coverage Guideline
Download PDF:
Annual Notice of Change
EasyCare
Annual Notice of Change
EasyCare Plus
Annual Notice of Change
Total
Annual Notice of Change
Summary of Benefits
EasyCare
Summary of Benefits
EasyCare Plus
Summary of Benefits