Medicare medical necessity criteria help provide a consistent clinical framework for reviewing whether certain healthcare services meet applicable standards for coverage. Understanding these criteria can give you greater clarity into what is considered during the review process and the clinical guidance that may apply to a service or treatment. Use the resources below to explore Wellcare’s clinical coverage guidelines and applicable InterQual medical necessity criteria, with more detailed information available for the services you’re reviewing.
Clinical Coverage Guidelines/Policies
InterQual® Medical Necessity Criteria
