CG-MED-83

Outpatient infusion therapy is covered when deemed medically necessary and provided in approved hospital outpatient departments, clinics, or certain home, office, and infusion center settings, particularly when skilled nursing supervision is required due to patient risk factors. Key requirements include documentation of medical necessity and structured clinical risk assessments, while limitations restrict coverage to designated settings and specific criteria, alongside possible prior authorization based on the member's plan. It is crucial to consult the member's contract for exact coverage details, as procedures or diagnoses may not guarantee reimbursement.

"Outpatient infusion therapy service is covered when provided in a hospital outpatient department or clinic."

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