Medical Necessity Supplementation Criteria

Evidence-based criteria by service category.

Browse Medical Necessity Supplementation Criteria by service category. Documents are listed alphabetically and are provided as PDF files that open directly in your browser for convenient viewing.

Service Category

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Cardiac Surgery

Cardiovascular

Dermatology

Diagnostic Testing

Durable Medical Equipment

ENT

Gastroenterology

General Surgery

Gynecology

Hematology

Interventional Radiology

Nephrology

Neurology

Neurosurgery

Oncology

Ophthalmology

Oral & Maxillofacial Surgery

Orthopedics

Pain Management

Perinatology

Plastic Surgery

Podiatry

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Pulmonology (Addendum - Polysomnography)

Radiation Oncology

Radiology

Rehabilitation

Retinal Specialist

Thoracic Surgery

Ultrasound

Urology

Vascular Surgery

Documents on this page are reviewed periodically and may be updated as clinical criteria change. Please refer to the latest available version when reviewing Medical Necessity Supplementation Criteria.