Coverage Determination Guidelines

Our Coverage Determination Guidelines are intended to standardize the interpretation and application of terms of the Member's Benefit Plan including terms of coverage, Benefit Plan exclusions and limitations.

Anxiety Disorder

Bipolar and Related Disorders

Custodial Care and Inpatient & Residential Services

Depressive Disorders (MDD, PDD, PMDD)

Disruptive, Impulse and Conduct Disorder

Dissociative Identity Disorders (DID)

Drug Testing

Gender Dysphoria

Feeding and Eating Disorder

Health & Behavior Assessment and Intervention

Home-Based Outpatient Treatment

Judicial or Administrative Proceedings or Orders (aka Court Ordered Treatment)

Neurocognitive Disorders (Dementia)

Neurodevelopmental Disorders

Obsessive Compulsive Disorder (OCD)

Other and Unspecified Disorders

Office-Based Opioid Treatment

Other Conditions That May Be a Focus of Clinical Attention (V-Codes)

Personality Disorders

Proven and Unproven Services

Psychological and Neuropsychological Testing

Schizophrenia and Schizoaffective Disorder

School-Based Services for Children and Adolescents

Substance-Related and Addictive Disorder

Telemental Health

Trauma & Stressor Related Disorders

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