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 | View | Download |
|---|---|---|
| Cardiac Surgery | View PDF | Download |
| Cardiovascular | View PDF | Download |
| Dermatology | View PDF | Download |
| Diagnostic Testing | View PDF | Download |
| Durable Medical Equipment | View PDF | Download |
| ENT | View PDF | Download |
| Gastroenterology | View PDF | Download |
| General Surgery | View PDF | Download |
| Gynecology | View PDF | Download |
| Hematology | View PDF | Download |
| Interventional Radiology | View PDF | Download |
| Nephrology | View PDF | Download |
| Neurology | View PDF | Download |
| Neurosurgery | View PDF | Download |
| Oncology | View PDF | Download |
| Ophthalmology | View PDF | Download |
| Oral & Maxillofacial Surgery | View PDF | Download |
| Orthopedics | View PDF | Download |
| Pain Management | View PDF | Download |
| Perinatology | View PDF | Download |
| Plastic Surgery | View PDF | Download |
| Podiatry | View PDF | Download |
| Pulmonology (Addendum - Polysomnography) | View PDF | Download |
| Radiation Oncology | View PDF | Download |
| Radiology | View PDF | Download |
| Rehabilitation | View PDF | Download |
| Retinal Specialist | View PDF | Download |
| Thoracic Surgery | View PDF | Download |
| Ultrasound | View PDF | Download |
| Urology | View PDF | Download |
| Vascular Surgery | View PDF | Download |
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.