Health Care Services Policies
To ensure consistent and appropriate review of requests for coverage for Medicare Members, MAHP follows Original Medicare Coverage Determinations for Medicare covered services. Local (LCD) and National (NCD) Coverage Determinations can be found on the CMS website.
Medicare Coverage Database
When a request is received by Health Care Services (HCS) for a particular item or service that is not addressed by the Original Medicare LCD or NCD, the HCS Nurse or Pharmacy Utilization Specialist is encouraged to:
- Utilize MAHP current software vendor for IA, IL, or WI specific Medicare coverage guidelines. If an NCD or LCD is not available, MAHP may utilize the vendor for other Medicare coverage policies from the most geographically appropriate region, or
- Utilize MAHP internally created coverage criteria based on current evidence in widely used treatment guidelines or clinical literature that is made publicly available, or
- Utilize MAHP software vendor for Commercial coverage when all other resources are not available.
Guidelines for Policies and Procedures
Acupuncture [PDF]
Aquatic Therapy [PDF]
Autism Spectrum [PDF]
Bariatric Surgery [PDF]
Cochlear Implants/Osseointegrating Auditory Device [PDF]
Diabetes Management [PDF]
Emergency Transporation [PDF]
Erectile Dysfunction [PDF]
Gender Affirmation [PDF]
Genetic Testing [PDF]
Glucose Testing Supplies [PDF]
Hospice Care Guidelines [PDF]
Private Duty Nursing [PDF]
Residential Treatment Criteria [PDF]
Skilled Nursing Facility Services [PDF]
Speech Therapy [PDF]
