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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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CUSTOMIZATION TO CARE GUIDELINES 25th EDITION

WebFebruary 11, 2021. This document provides a high level summary of customizations and modifications to MCG Care Guidelines, collectively, “customized guidelines.”1234 The …

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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-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-MED-26 Neonatal Levels of Care

WebIn 2012 (reaffirmed 2015), the AAP issued a policy statement outlining the designations of levels of neonatal care to distinguish and standardize newborn care …

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

WebPDN is defined as the provision of medically necessary, complex skilled nursing care in the home by an RN or an LPN/LVN. The purpose of PDN is to assess, …

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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-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-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-83 Bariatric Surgery and Other Treatments for

WebBariatric Surgery to Treat Indications Other than Obesity. The rates of metabolic diseases, such as diabetes and nonalcoholic fatty liver diseases (NAFLD) …

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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-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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ADMIN.00002 Preventive MedUSafelines

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

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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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SURG.00023 Breast Procedures; including Reconstructive Surgery

WebDescription/Scope. This document addresses the following three areas: reconstructive breast surgery, cosmetic surgeries designed to enhance the appearance …

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