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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.

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Acupuncture Authorization Guideline
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Behavioral Health Services
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Dental Services (Coming Soon)
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Medical Necessity and Other Clinical Coverage Criteria (Coming Soon)
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Outpatient Physical, Occupational, and Speech Therapy Coverage Guideline
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