EviCore Healthcare Post-Acute Care and Home Health Care Clinical Guidelines for Medical Necessity

Covers prior authorization determinations for post‑acute care and home health services using MCG evidence‑based guidelines and, for Medicare members, the Medicare Benefit Policy Manual; the excerpt contains no specific covered diagnoses, ICD‑10 codes, frequency limits, age limits or explicit exclusions. Key requirements: services require prior authorization and medical necessity/documentation must follow the cited MCG guidance and Medicare Benefit Policy Manual (for Medicare members), with additional criteria possible beyond the excerpt.

"Post-Acute Care Prior Authorization Criteria (i."

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