Medical Policies

The CareSource Medical Policies offer guidance on determination of medical necessity and appropriateness of care for approved benefits. Benefit determinations and coverage decisions are subject to all the terms and conditions of CareSource including eligibility, definitions, specific inclusions or exclusions, and applicable state or federal laws.

The medical policies do not constitute medical advice or medical care. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. CareSource is not responsible for, does not provide, and does not represent itself as a provider of medical care.

Policies are considered guidelines and are not intended to infer benefits or coverage for a specific member. Benefit determinations are based on the specific facts of each member’s case. If a service or supply is not eligible for coverage, a member and the treating provider may proceed with that service or supply after receiving a denial from CareSource for the requested non-covered service.

Policies are regularly reviewed, updated, withdrawn or added and therefore, subject to change. Please check back often for updates on CareSource's Medical Policies.

Effective June 15, 2011

June 15, 2011, CareSource will change its requirements on specialty pharmacy Prior Authorization (PA). CareSource uses evidence-based guidelines to ensure health care services or medications meet the standards of excellent medical practice and are the lowest cost alternative for the member. These new requirements ensure appropriate use of these medications.

Specialty pharmacy medications are listed in alphabetical order by brand name and generic name.

Prior Authorizations must include:

  • Please complete the Prior Authorization form
  • The J-code and NDC # must be submitted with the requested drugs
  • Supporting Clinical Documentation
  • CareSource has created a quick reference guide, which includes the J-code and NDC codes for providers submitting PA requests starting June 15. The medical policies on these medications are listed below for your reference.

2011

17 Alpha Hydroxyprogesterone
ABA Therapy
Accommodation During Transplant Surgery
Breast Reconstruction Surgery
Breast Reduction
Cochlear Implants
Cranial Orthotics: Remodeling Helmet/Band
Emergency Response System - New 12/2011
Experimental or Investigational Technologies
Flu Vaccine
Genetic Testing
Growth Hormone
Keloid Repair
Mastectomy for Gynecomastia - Updated 12/2011
Medication Dispenser Policy - Updated 12/2011
National and Local Coverage Determinations
Nutritional Supplement - Updated 12/2011
Obesity Surgery - Updated 12/2011
Obesity Surgery in Adolescents
Observation Care Criteria
Pain Management Interventional Procedures - Updated 12/2011
Panniculectomy - Updated 12/2011
Seat Lift Mechanism (Uplift Seat Assist)
Septoplasty
Suboxone / Subutex - New 12/2011
Tocolysis Policy
Vacuum Assisted Wound Therapy - Updated 12/2011
Ultrasound for Pregnancy

 

2010 Medical Policies