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CG-MED-71 Chronic Wound Care in the Home or Outpatient Setting

WebMedically Necessary: Note: To be eligible for wound care in the home setting, the individual must be confined to the home as defined in CG-MED-23 Home Health. …

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CG-MED-23 Home Health

WebG0153. Services performed by a qualified speech-language pathologist in the home health or hospice setting, each 15 minutes. G0155. Services of clinical social worker in home …

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Full list of Medical Policies and Clinical Guidelines

WebANC.00006 Biomagnetic Therapy. 06/28/2023. Medical Policy. Ancillary, Miscellaneous. ANC.00007 Cosmetic and Reconstructive Services: Skin Related. …

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Participating Provider Quick Reference Card

Webn Hospital admissions The following contact information should be used in the event of a hospital admission: n provider to inform Amerigroup of the intent to render Notification of …

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CG-REHAB-12 Rehabilitative and Habilitative Services in

WebMedically Necessary: Physical therapy, occupational therapy, or speech-language pathology services in the home setting are considered medically necessary …

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CG-DME-23 Lifting Devices for Use in the Home

WebGuideline #: CG-DME-23. Publish Date: 09/27/2023. Status: Reviewed. Last Review Date: 08/10/2023. Description. This document addresses lifting devices for use …

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CG-MED-19 Custodial Care

WebSubject: Custodial Care. Guideline #: CG-MED-19. Publish Date: 01/03/2024. Status: Revised. Last Review Date: 11/09/2023. Description. This document defines …

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CG-REHAB-08 Private Duty Nursing in the Home Setting

WebDescription. This document defines private duty nursing (PDN) in the home and the conditions under which it would be considered medically necessary. PDN refers …

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CG-MED-37 Intensive Programs for Pediatric Feeding Disorders

WebDescription. This document addresses the use of intensive programs for pediatric feeding disorders. The term "feeding disorder" refers to a condition in which an …

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CG-BEH-14 Intensive In-home Behavioral Health Services

WebMedically Necessary:. Intensive in-home behavioral health services may be considered medically necessary when ALL of the following selection criteria are met (A, …

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CG-DME-33 Wheeled Mobility Devices: Manual Wheelchairs

WebAn ultra- lightweight manual wheelchair is constructed of high strength materials and weighs less than 30 lbs. Note: Please see the following related documents …

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CG-LAB-09 Drug Testing or Screening in the Context of

WebDescription. This document addresses the use of drug testing (using urine, blood, saliva, sweat or hair) in the outpatient setting for adherence monitoring in the …

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CG-DME-16 Pressure Reducing Support Surfaces

WebThe use of the group 2 support surface is medically necessary for wound management. When a group 2 pressure reducing support surface is prescribed following …

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CG-SURG-103 Penile Circumcision

WebElective penile circumcision of an infant in the newborn period is outside the scope of this guideline. Guidelines by American Urological Association (AUA, 2018), …

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CG-DME-07 Augmentative and Alternative Communication (AAC …

WebMedically Necessary: Augmentative and alternative communication devices with digitized or synthesized speech output are considered medically necessary when all …

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CG-BEH-02 Adaptive Behavioral Treatment

WebThis guideline is to be applied to the extent there is a state mandate or specific benefit coverage for an Adaptive Behavioral Treatment (ABT) such as Intensive …

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CG-ADMIN-01 Clinical Utilization Management (UM) Guideline

WebSubject: Clinical Utilization Management (UM) Guideline for Pre-Payment Review Medical Necessity Determinations When No Other Clinical UM Guideline Exists …

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CG-DME-43 High Frequency Chest Compression Devices for

WebHigh-frequency chest compression (HFCC): A treatment designed to help improve secretion clearance for individuals suffering from excessive or retained lung …

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ADMIN.00002 Preventive MedRXweblines

WebSubject: Preventive MedRXweblines. Document #: ADMIN.00002. Publish Date: 06/28/2023. Status: Reviewed. Last Review Date: 05/11/2023. Description/Scope. …

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